Cardiovascular Disease Risk In Adults Research Articles

Non-fasting lipids and cardiovascular disease in those with and without diabetes in Alberta's Tomorrow Project: a prospective cohort study.

Non-fasting remnant cholesterol (RC) is a novel marker of cardiovascular disease (CVD) risk, however data on this relationship in Canadians with diabetes (at high risk of CVD) is lacking. The objective of this analysis was to determine the relationship of RC with CVD in individuals with and without diabetes in the Alberta's Tomorrow Project (ATP) cohort. Non-fasting lipid data collected as part of the ATP was linked to administrative health records (October 2000 - March 2015) to ascertain incident CVD and prevalent diabetes. Participants without prevalent CVD or incident diabetes and who had complete, non-negative non-fasting lipid data collected with triglycerides <4.5mmol/L were included (n=13,631). The relationship between non-fasting RC and incident CVD diagnoses was assessed by Cox proportional hazards regression, after stratification by diabetes status. Participants were 69.8% women with a mean age of 61.6±9.7 years, and 6.5% had prevalent diabetes. Non-fasting RC was higher in participants with diabetes compared to those without (mean 0.94±0.41mmol/L vs. 0.77±0.38mmol/L, p<0.0001) and was associated with increased risk of incident CVD among those without diabetes (adjusted hazard ratio (aHR) 1.22, 95% CI 1.03-1.43, p=0.02). Although a similar trend was observed in participants with diabetes it did not reach statistical significance (aHR 1.31, 95% CI 0.84-2.05, p=0.23). Elevated non-fasting RC predicted increased CVD risk in middle and older-aged adults without diabetes; similar trends were observed in participants with diabetes and requires further testing in a larger sample.

0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood Pressure During Late Adolescence

Abstract Introduction Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence. Methods This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions. Results This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p &amp;lt; 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model. Conclusion This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group. Support (if any) 1st author - NHLBI T32HL105349 &amp; NICHD 5T32HD101397-03

Impaired Endothelial Vasomotor Function with Borderline-High Triglycerides

Approximately 1 in 3 adults in the United States have a triglyceride (TG) concentration above 150 mg/dL and 1 in 5 adults have TG levels 200 mg/dL or higher. Moreover, the prevalence of suboptimal TGs (&gt;150 mg/dL) has increased 5-fold in middle-aged and older adults over the last 3 decades. While much attention has focused on the cardiovascular effects of high and very high TG levels, where other lipid and metabolic abnormalities are often present, there are currently little data on the influence of borderline-high TG concentrations on vascular health. This represents a critical void in our understanding of the pathogenesis of cardiovascular disease (CVD) with TGs. Impaired endothelial vasomotor function is a central etiologic feature in the development of CVD and associated thrombotic events. We tested the hypothesis that endothelium-dependent vasomotor function is impaired in adults with borderline-high TG concentrations. Thirty-two sedentary, adults were studied: 15 (7M/8F, age: 56±1 yr; BMI: 26.8±0.6 kg/m2) with normal TG (35-140 mg/dL) and 17 (9M/8F, age: 57±1 yr; BMI: 28.7±0.8 kg/m2) with borderline-high TG (150-199 mg/dL) levels. Forearm blood flow (FBF; plethysmography) was determined in response to the intra-arterial infusion: acetylcholine (ACh) (4.0, 8.0, and 16.0 mg/100 mL tissue/min), sodium nitroprusside (1.0, 2.0, and 4.0 mg/100 mL tissue/min) and selective ETa receptor blocker (BQ-123, 100 nmol/min for 60 min). FBF response to ACh was significantly lower (~20%) in the borderline-high TG (from 4.7±0.3 to 11.6+0.6 mL/100 mL tissue/min) vs normal TG (from 4.3±0.3 to 14.6±0.5 mL/100 mL tissue/min) group. There were no significant group differences in the FBF responses to sodium nitroprusside. BQ-123 elicited a significant vasodilator response (~20%) in the borderline-high TG adults but did not alter FBF in the normal TG adults. Co-infusion of BQ-123 did not affect FBF responses to ACh in normal TG group but resulted in an ~30% increase in Ach-induced vasodilation (from 4.3±0.4 to 15.1±0.7 mL/100 mL tissue/min; P&lt;0.05) in borderline-high TG group. Triglyceride levels were significantly and inversely associated with total FBF response to ACh (r=-0.63) and positively associated with the peak FBF response to BQ-123 (r=0.53; P&lt;0.05). These results indicate that borderline-high TG concentrations are associated with diminished endothelium-dependent vasodilation and enhanced ET-1-mediated vasoconstrictor tone. Impaired endothelial vasomotor function may underlie the increased risk of CVD in adults with borderline-high TG levels. Nothing to disclose This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Chronic Electronic Cigarette Users Exhibit Reduced Cardiorespiratory Fitness and Associated Increased Cardiovascular Disease Risk

BACKGROUND: Electronic cigarettes (e-cigs) are popular tobacco products that are currently advertised as a safer alternative to traditional cigarettes. Preliminary data, primarily from animal studies, suggests that e-cigs are associated with an increased cardiovascular disease (CVD) risk. Cardiorespiratory fitness is a marker of cardiovascular (CV) health and a predictor of CV mortality, which is diminished in traditional tobacco users. However, the effect of chronic e-cigs usage on cardiorespiratory fitness and associated CVD risk in otherwise healthy individuals without established CVD or CVD risk factor, is currently unknown. PURPOSE: The purpose of this study was to investigate the impact of chronic e-cig use on cardiorespiratory fitness and CVD risk in healthy young adults. METHODS: Ten chronic e-cig users (ECU, 4 males and 6 females; age: 24±3 yr; e-cigs usage 3±1.5 yr.) and ten demographical matched, never users (NU, 4 males and 6 females; age: 22.7±2 yr.) participated in this study. Cardiorespiratory fitness was measured by peak oxygen consumption (VO2peak) via a respiratory gas exchange analyzer during a cardiopulmonary exercise test. CVD risk was calculated using Framingham’s 30-year CVD risk score accounting for 8 risk factors (age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein, presence of diabetes mellitus, hypertension treatment, and smoking status). RESULTS: Chronic e-cig users exhibited significantly lower VO2peak (ECU vs. NU; 30.9±4.9 vs. 37.8±6.4 ml/kg/min; p=0.015) and percent predicted (ECU vs. NU; 85.9±16 vs. 105.4±14 % predicted; p=0.001) when compared to never users. Framingham’s 30-year CVD risk score was significantly higher in ECU than in NU (7.7± 4.8, vs. 2.7±0.8 %; p=0.017). Furthermore, an inverse association was identified between VO2peak and 30-year CVD risk ( r=-0.720; p= 0.030). CONCLUSIONS: For the first time, we have identified significantly reduced cardiorespiratory fitness, a marker of CV health and mortality risk, in chronic e-cig users when compared to never users. In addition, chronic e-cig users exhibit higher CVD risk scores. Results from our study imply a negative effect of chronic e-cig use on CV health in otherwise young, apparently healthy adults. Future studies are warranted to investigate the long-term effects of e-cig use on CV health. Supported in part by a Rapid Response Project NIDA/FDA (PRM). Supported in part by a Rapid Response Project NIDA/FDA (PRM). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Biological sex influences aortic hemodynamic responses to maximal exercise in healthy older adults

Aging is associated with stiffening of large elastic arteries resulting in early wave reflection, which increases aortic systolic blood pressure (BP) and left ventricular afterload. These age-related alterations predispose older adults to cardiovascular disease (CVD). Exercise is recommended for reducing CVD risk in older adults, but the acute aortic hemodynamic responses to exercise have not been fully described. We have previously shown that exercise intensity influences acute aortic hemodynamic responses to submaximal exercise in older adults, however, the responses to maximal exercise have not been investigated. In young adults, the influence of maximal exercise on aortic wave characteristics is impacted by sex. Therefore, the objective of this study was to investigate the acute effects of maximal exercise on aortic wave characteristics in healthy older adults and to test the hypothesis that the acute aortic hemodynamic responses to maximal exercise will be influenced by sex. Twenty-two older men and postmenopausal women (66.4±1.0 yrs, mean±SE, 11M/11W) completed the study. Research participants were free of major clinical disease, were not using hormone replacement therapy or participating in endurance exercise training. Aortic wave characteristics were assessed using wave separation analysis (SphygmoCor XCEL) before and immediately after maximal exercise, based on a modified Balke treadmill test. We found that wave reflection, assessed as augmentation index (AIx) at heart rate of 75 bpm (AIx@75), was not different between older men and women prior to maximal exercise ( P=0.2). Following maximal exercise, AIx@75 increased in older men (21.1±2.6 vs. 28.2±2.4 %, pre- vs. post-exercise, P=0.02) and women (27.4±3.3 vs. 33.9±3.2 %, P=0.03), but the response was not influenced by sex ( P=0.9 for sex × time interaction). Aortic systolic and diastolic BP (AoSBP and AoDBP) were not different in older men compared with women prior to maximal exercise ( P≥0.4). In response to maximal exercise, AoSBP and AoDBP significantly increased in older men (AoSBP: 113±3 vs. 118±2 mmHg, P=0.01 and AoDBP: 75±2 vs. 80±2 mmHg, P&lt;0.01), but not in women (AoSBP: 113±4 vs. 113±4 mmHg, P=0.9; P=0.04 for sex × time interaction and AoDBP: 73±2 vs. 74±2 mmHg, P=0.054; P=0.02 for sex × time interaction). In conclusion, sex influences the aortic BP response to maximal exercise, but not the wave reflection response in older adults. This finding suggests that left ventricular afterload remains elevated during recovery from maximal exercise in older men which may differentially expose them to a transient risk of experiencing a cardiac complication. This work was supported by National Institute of Aging grant AG063143. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Long-term exposure to ambient PM2·5, active commuting, and farming activity and cardiovascular disease risk in adults in China: a prospective cohort study

Increased physical activity is associated with a reduced risk of cardiovascular disease, but outdoor physical activity can be accompanied by increased inhalation of fine particulate matter (PM2·5). The extent to which long-term exposure to PM2·5 can offset the cardiovascular benefits of physical activity is unknown. We aimed to evaluate whether the associations between active commuting or farming activity and incident risks of cerebrovascular disease and ischaemic heart disease were consistent between populations with different ambient PM2·5 exposures. We did a prospective cohort study using data from people aged 30-79 years without cardiovascular disease at baseline from the China Kadoorie Biobank (CKB). Active commuting and farming activity were assessed at baseline using questionnaires. A high-resolution (1 × 1 km) satellite-based model was used to estimate annual average PM2·5 exposure during the study period. Participants were stratified according to PM2·5 exposure (54 μg/m3 or greater vs less than 54 μg/m3). Hazard ratios (HRs) and 95% CIs for incident cerebrovascular disease and ischaemic heart disease by active commuting and farming activity were estimated using Cox proportional hazard models. Effect modifications by PM2·5 exposure were tested by likelihood ratio tests. Analyses were restricted to the period from Jan 1, 2005, to Dec 31, 2017. Between June 25, 2004, and July 15, 2008, 512 725 people were enrolled in the CKB cohort. 322 399 eligible participants completed the baseline survey and were included in the analysis of active commuting (118 274 non-farmers and 204 125 farmers). Among 204 125 farmers, 2985 reported no farming time and 201 140 were included in the farming activity analysis. During a median follow-up of 11 years, 39 514 cerebrovascular disease cases and 22 313 ischaemic heart disease cases were newly identified. Among non-farmers with exposure to annual average PM2·5 concentrations of less than 54 μg/m3, increased active commuting was associated with lower risks of cerebrovascular disease (highest active commuting vs lowest active commuting HR 0·70, 95% CI 0·65-0·76) and ischaemic heart disease (0·60, 0·54-0·66). However, among non-farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater, there was no association between active commuting and cerebrovascular disease or ischaemic heart disease. Among farmers with exposure to annual average PM2·5 concentrations of less than 54 μg/m3, increased active commuting (highest active commuting vs lowest active commuting HR 0·77, 95% CI 0·63-0·93) and increased farming activity (highest activity vs lowest activity HR 0·85, 95% CI 0·79-0·92) were both associated with a lower cerebrovascular disease risk. However, among farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater, increases in active commuting (highest active commuting vs lowest active commuting HR 1·12, 95% CI 1·05-1·19) and farming activity (highest activity vs lowest activity HR 1·18, 95% CI 1·09-1·28) were associated with an elevated cerebrovascular disease risk. The above associations differed significantly between PM2·5 strata (all interaction p values <0·0001). For participants with long-term exposure to higher ambient PM2·5 concentrations, the cardiovascular benefits of active commuting and farming activity were significantly attenuated. Higher levels of active commuting and farming activity even increased the cerebrovascular disease risk among farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater. National Natural Science Foundation of China, National Key Research and Development Program of China, Kadoorie Charitable Foundation, UK Wellcome Trust.

Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes

Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice. To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]). Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies. Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590). The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences). Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P < .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]). A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease. ClinicalTrials.gov Identifier: NCT03936660.

Abstract MP38: Higher Childhood Cardiovascular Risk Score is Associated With Worse Physical, Social and Emotional Functioning in Adulthood

Introduction: Childhood cardiovascular risk factors have been associated with increased risk of adult cardiovascular disease, but how they are associated with adult physical, emotional and social functioning is not well understood. Hypothesis: We addressed the hypothesis that the International Childhood Cardiovascular Cohort (i3C) Consortium childhood risk score would be associated with worse physical, social and emotional functioning in adulthood. Methods: The i3C childhood combined risk score is the average of five childhood risk factors (body mass index, systolic blood pressure, youth smoking, total cholesterol and triglycerides) on the z-score scale. Self-reported measures of physical (e.g., pain, functioning, fatigue), social (e.g., social isolation, satisfaction with social role) and emotional functioning (e.g., anxiety, depression) were assessed in adulthood in a subset of two i3C cohorts, the NHLBI Growth and Health Study (NGHS) and the Princeton Lipid Research Study (PLRS). Potential covariates included cohort (as a proxy for age, given no overlap in ages between cohorts), sex, race (Black vs. White), own education, parental education, marital status, and self-reported hypertension, diabetes and cancer. Interactions between the i3C risk score and cohort (age) were evaluated. Results: Ninety-two NGHS (100% female, 46% Black, mean±SD age 44.5±0.6 years) and 75 PLRS (77% female, 31% Black, 60.6±3.4 years) participants were included in analyses. In adjusted models, a higher i3C risk score was associated with worse physical functioning, global pain score, pain interference with everyday activities, and fatigue in the older PLRS participants, but only with global pain score in the younger NGHS participants (all p[int]&lt;0.05 except global pain). Higher i3C childhood risk score was associated with greater sleep-related impairment in PLRS, but with less impairment in NGHS participants (p[int]=0.03). Higher i3C childhood risk score was also associated with higher depression scores and less satisfaction with social roles in PLRS participants but not NGHS participants (p[int]=0.02 and 0.04, respectively). There was no significant relationship of i3C risk score with sleep quality, friendships, social isolation or anxiety. Conclusions: In conclusion, higher childhood cardiovascular risk factors are associated with worse physical, social and emotional health in adulthood, even in this limited sample of predominantly Black and White women followed from childhood. These effects are more prominent in older than younger adults, when issues such as pain and sleep problems become more prevalent.

Abstract P331: Higher Allostatic Load Score is Associated With Early Cardiovascular Risk in Young South Africans. The AfricanPREDICT Study

Background: The Allostatic load score (ALS) is a composite score that measures the cumulative physiological burden of sustained exposure to stress and biological dysregulation. ALS has markers capture risk in 4 domains (neuro-endocrine, metabolic, cardiovascular, and immunological). Higher ALS in adults predict cardiovascular disease (CVD), but it is unknown whether ALS is associated with CVD risk in youth and young adults (YA), and whether the risk and association would differ at such an early age. Aims: In youth and YA we compared 1) the total ALS; 2) the cardiovascular profile according to high and low ALS; and 3) the association of ALS with markers of CVD. Methods: Participants in the African PRospective study on the Early Detection and Identification of Cardiovascular disease and HyperTension (AfricanPREDICT) were 587 youth&lt;24years (48% Male, 21±2 years) and 579 YA≥24years (49% Male, 27±2 years) were evaluated. The ALS was calculated from fasting biomarkers using the upper quartile population distribution of dehydroepiandrosterone (DHEA), cortisol, interleukin-6 (IL-6), C-reactive protein (hsCRP), BMI, systolic-BP, diastolic-BP, and lower quartile of HDL-cholesterol. The upper quartile of ALS in the whole population was defined as high ALS. Retinal vessel analyses, pulse wave velocity, and echocardiography were obtained and associations with ALS determined by regression analyses adjusted for sex, ethnicity, cotinine, gamma-glutamyl-transferase (GGT) and physical activity. Results: ALS median range was 1-8, and a high ALS of &gt;3 was observed in 35% of youth, and 47% YA. In youth with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.16, β-coefficient, -1.73, (95%CI), -2.95, -0.94), P =0.052), greater pulse wave velocity (Adj R 2 :0.56, 0.75 (0.48, 1.98), P =0.021), increased left ventricular mass index (Adj R 2 :0.61, 2.21 (0.43, 8.46) P =0.048), lower left ventricular function (global longitudinal strain) (Adj R 2 :0.37, -0.45 (-1.06, -0.06) P =0.015). Similarly, in YA with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.43, -4.54 (-6.58, -2.50), P &lt;0.001), greater pulse wave velocity (Adj R 2 :0.44, 0.62 (0.09, 1.17), P =0.043), increased left ventricular mass index (Adj R 2 :0.53, 2.62 (1.52, 5.76) P =0.032), lower diastolic function (E/A ratio) (Adj R 2 :0.27, -0.11 (-0.18, -0.04) P =0.002). Conclusion: Youth and YA with high ALS had a more adverse CVD risk profile and greater association with markers of cardiovascular aging compared to their low ALS counterparts. ALS and allostatic dysregulation should be evaluated in youth and YA, when assessing current and future cardiovascular risk.

The association of BP with cardiovascular outcomes in patients with dipstick proteinuria and preserved kidney function.

Little is known about the relationship between blood pressure (BP) and incident cardiovascular disease (CVD) in people with proteinuria and a preserved estimated glomerular filtration rate (eGFR). This study sought to investigate the association of BP with CVD risk in adults with proteinuria and preserved eGFR. We studied 188,837 individuals with proteinuria and preserved eGFR ≥60 mL/min/1.73 m2. We categorized individuals who were not taking BP-lowering medications into four groups based on the 2017 American College of Cardiology/American Heart Association BP guideline and categorized those who were taking BP-lowering medications using the same BP ranges. The primary outcome was a composite CVD endpoint that included myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up of 1,050 days, 7,039 CVD events were identified. Compared with normal BP, stage 1 hypertension (hazard ratio [HR]: 1.30, 95% confidence interval [95% CI]: 1.21-1.40) and stage 2 hypertension (HR: 2.17, 95% CI: 2.01-2.34) were associated with an increased risk for CVD events among medication-naïve individuals. Only stage 2 hypertension range (HR: 1.19, 95% CI: 1.02-1.38) was associated with an increased CVD event risk among people taking BP-lowering medications. Restricted cubic spline analysis showed that the risk of CVD events increased monotonically with BP at an SBP/DBP > 120/80 mmHg among medication-naïve individuals, but risk increased only at an SBP/DBP > 140/90 mmHg among individuals taking BP-lowering medications. In conclusion, among people with proteinuria and preserved eGFR, stage 1 and stage 2 hypertension were associated with a greater risk of CVD among medication-naïve individuals, whereas only stage 2 hypertension was associated with an increased CVD risk among those taking BP-lowering medications.

Peers’ parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RationaleAlthough there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers’ parents is associated with improved physical health in adulthood. ObjectiveThis study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers’ parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits). MethodsData from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents’ adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted. ResultsThe results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education—that is, about a 0.98-year increase in grademates’ parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association. ConclusionThe study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers’ highly educated parents.

Adverse childhood experiences are associated with vascular changes in adolescents that are risk factors for future cardiovascular disease

BackgroundAdverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are associated with a higher risk of cardiovascular disease (CVD) and indicators of future CVD risk in adulthood, such as greater vascular stiffness. The impact of ACEs in adolescence is unclear, and understanding how ACEs relate to blood pressure (BP) and vascular function during early life is key for the development of prevention strategies to reduce CVD risk. We hypothesized that exposure to ACEs would be associated with changes in central hemodynamics such as increased vascular stiffness and higher BP during adolescence.MethodsThis pilot study enrolled 86 adolescents recruited from the Children’s of Alabama. A validated ACE questionnaire was employed, and ACEs were modeled both as a continuous variable and a categorical variable (ACE ≥ 1 vs. ACE = 0). The primary outcomes used are considered to be indicators of future cardio-renal disease risk: aortic augmentation index normalized to 75 bpm (Alx75, a surrogate for vascular stiffness), carotid-femoral PWV (m/s), and ambulatory BP patterns.ResultsAdolescents with ACE ≥ 1 had significantly higher Alx75 (ACE: 5.2% ± 2.2 compared to no ACE: − 1.4% ± 3.0; p = 0.043). PWV only reflected this trend when adjustments were made for the body mass index. Adolescents with ACEs showed no differences in ambulatory BP patterns during the 24-h, wake, or sleep periods compared to adolescents with no ACEs.ConclusionsACEs were associated with higher AIx75 in adolescence, which is a risk factor for future CVD. Adolescence could present an opportunity for early detections/interventions to mitigate adverse cardiovascular outcomes in adulthood.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Longitudinal pathways from adolescent depressive symptoms to cardiovascular disease risk in adulthood

RationaleDespite existing literature on the impact of adolescent depressive symptoms on a variety of youth outcomes, little is known about whether and how adolescent depressive symptoms are associated with physical health in adulthood. ObjectiveThis study aimed to investigate the longitudinal association between adolescent depressive symptoms and cardiovascular disease (CVD) risk in adulthood. An extensive list of potential mechanisms underlying this association, including health behaviors, substance use, academic effort and achievement, and school-based relationships, was also examined. MethodsUsing the sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3011), this study employed sibling fixed-effects models to address unobservable family-level confounders, such as genetic factors, parental and familial characteristics, and school and neighborhood environments. ResultsAdolescent depressive symptoms were associated with an increased risk of CVD in about 13 years later (b = 0.698). Sibling fixed-effects estimates revealed that, despite some attenuation (approximately 31%), this association is robust to adjustment for unobserved family-level heterogeneity. Substance use and academic effort/achievement explained about 35% and 16% of the association between adolescent depressive symptoms and adult CVD risk, respectively. In contrast, health behaviors and school-based relationships played little or no role in mediating the association. ConclusionThe findings of this study suggest that policymakers and practitioners may wish to develop interventions to reduce adolescent depressive symptoms and to help adolescents with depressive symptoms avoid substance use and promote effort in school. Early interventions targeting adolescents with depressive symptoms may be a cost-effective strategy for preventing adult physical health problems.

The joint effect between fetal growth and health behaviors on the risk of cardiovascular diseases in young adulthood

To investigate the individual and the joint effect of impaired fetal growth and adult health behaviors on the risk of cardiovascular diseases (CVDs). A total of 15,618 individuals were included from three sub-cohorts of the Stockholm Public Health Cohort. Data on participants' birthweight and gestational age were retrieved from the Medical Birth Register. Data on the diagnoses of CVDs were extracted from the Swedish National Patient Register and the Cause of Death Register. Data on health behaviors were identified from self-reported questionnaires, and health behavioral profile was defined based on the recommendations of the American Health Association. The associations of fetal growth and health behaviors with the risk of CVDs were analyzed using Cox proportional hazard model. Individuals born small for gestational age (SGA) had a higher risk of CVDs than those born appropriate for gestational age (AGA), and the adjusted hazard ratio (HR) and 95% confidence interval (CI) was 1.88 (1.44, 2.47). Participants born SGA and having poor health behavioral profile in adulthood had a higher risk of CVDs than those born AGA and having ideal health behaviors with adjusted HR (95% CI) being 3.58 (1.95, 6.56). Impaired fetal growth was associated with an increased risk of CVDs in adulthood, and the risk was highest in individuals with both impaired fetal growth and poor health behaviors in adulthood.

Overweight or obesity increases the risk of cardiovascular disease among older Australian adults, even in the absence of cardiometabolic risk factors: a Bayesian survival analysis from the Hunter Community Study.

To estimate the risk of cardiovascular disease (CVD) in older adults with overweight or obesity without metabolic risk factors using a Bayesian survival analysis. Prospective cohort study with median follow-up of 9.7 years. Newcastle, New South Wales, Australia. A total of 2313 community-dwelling older men and women. Participants without known CVD and with a body mass index (BMI) ≥ 18.5 kg m2 were stratified by BMI and metabolic risk to create six BMI-metabolic health categories. Metabolic risk was defined according to the International Diabetes Federation criteria for metabolic syndrome. 'Metabolically healthy' was defined as absence of metabolic risk factors. Bayesian survival analysis, incorporating prior information from a previously published meta-analysis was used to assess the effect of BMI-metabolic health categories on time from recruitment to CVD. Incident physician-diagnosed CVD, defined as fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, angina, or coronary revascularisation procedure, was determined by linkage to hospital admissions records and Medicare Australia data. Secondary outcomes were cardiovascular mortality and all-cause mortality. From 2313 adults with complete metabolic health data over a median follow-up of 9.7 years, 283 incident CVD events, 58 CVD related deaths and 277 deaths from any cause occurred. In an adjusted Bayesian survival model of complete cases with informative prior and metabolically healthy normal weight as the reference group, the risk of CVD was increased in metabolically healthy overweight (HR = 1.52, 95% credible interval 0.96-2.36), and in metabolically healthy obesity (HR = 1.86, 95% credible interval 1.14-3.08). Imputation of missing metabolic health and confounding data did not change the results. There was increased risk of CVD in older adults with overweight or obesity, even in the absence of any metabolic abnormality. This argues against the notion of 'metabolically healthy' overweight or obesity.

Greater adherence to the 2019 Canada’s Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data

Canada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown. The aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD. Participants were a sample of adults without history of CVD, diabetes, or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated Web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019, which has a maximum of 80 points. The CVD outcome was a composite of fatal and nonfatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score. A total of 136,698 participants met the eligibility criteria (55% females; mean age: 57.2 y; range: 40-75 y). During the 11-y follow-up, there were 2843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) hypothetically reduced the risk of CVD by 24% (RR: 0.76; 95% CI: 0.58, 0.94; absolute risk difference: -0.58%). These results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-y risk of CVD in middle-aged and older adults.

Clinician perceptions of a clinical decision support system to reduce cardiovascular risk among prediabetes patients in a predominantly rural healthcare system

BackgroundThe early detection and management of uncontrolled cardiovascular risk factors among prediabetes patients can prevent cardiovascular disease (CVD). Prediabetes increases the risk of CVD, which is a leading cause of death in the United States. CVD clinical decision support (CDS) in primary care settings has the potential to reduce cardiovascular risk in patients with prediabetes while potentially saving clinicians time. The objective of this study is to understand primary care clinician (PCC) perceptions of a CDS system designed to reduce CVD risk in adults with prediabetes.MethodsWe administered pre-CDS implementation (6/30/2016 to 8/25/2016) (n = 183, 61% response rate) and post-CDS implementation (6/12/2019 to 8/7/2019) (n = 131, 44.5% response rate) independent cross-sectional electronic surveys to PCCs at 36 randomized primary care clinics participating in a federally funded study of a CVD risk reduction CDS tool. Surveys assessed PCC demographics, experiences in delivering prediabetes care, perceptions of CDS impact on shared decision making, perception of CDS impact on control of major CVD risk factors, and overall perceptions of the CDS tool when managing cardiovascular risk.ResultsWe found few significant differences when comparing pre- and post-implementation responses across CDS intervention and usual care (UC) clinics. A majority of PCCs felt well-prepared to discuss CVD risk factor control with patients both pre- and post-implementation. About 73% of PCCs at CDS intervention clinics agreed that the CDS helped improve risk control, 68% reported the CDS added value to patient clinic visits, and 72% reported they would recommend use of this CDS system to colleagues. However, most PCCs disagreed that the CDS saves time talking about preventing diabetes or CVD, and most PCCs also did not find the clinical domains useful, nor did PCCs believe that the clinical domains were useful in getting patients to take action. Finally, only about 38% reported they were satisfied with the CDS.ConclusionsThese results improve our understanding of CDS user experience and can be used to guide iterative improvement of the CDS. While most PCCs agreed the CDS improves CVD and diabetes risk factor control, they were generally not satisfied with the CDS. Moreover, only 40–50% agreed that specific suggestions on clinical domains helped patients to take action. In spite of this, an overwhelming majority reported they would recommend the CDS to colleagues, pointing for the need to improve upon the current CDS.Trial registration: NCT02759055 03/05/2016.

Effects of fetal famine exposure on the cardiovascular disease risk in the metabolic syndrome individuals

BackgroundPatients with metabolic syndrome (MS) have a higher incidence of cardiovascular disease (CVD), but the possible mechanisms are not fully understood and further exploration of the possible factors influencing the high incidence of CVD in patients with MS is still needed.ObjectivesThis study aims to examine the association between fetal famine exposure and the risk of CVD in adulthood with MS.MethodsOf 13,744 MS patients free of CVD selected from the Kailuan Study in 2006 (referred as the baseline survey) were included in the study. China suffered a severe famine from 1959 to 1962, so the participants born during this period were classified as the uterine famine exposed group. All patients were born between January 1, 1949, and December 31, 1974. Based on the date of birth, all patients were divided into the no-exposed group (born between January 1, 1963, and December 31, 1974), uterine famine exposed group (born between January 1, 1959 and December 31, 1962), and childhood famine exposed group (born between January 1, 1949 and December 31, 1958). After following up to December 31, 2019, the weighted Cox regression analysis model was used to calculate the effect of early life famine exposure in MS individuals on the risk of CVD in adulthood.ResultsDuring the 12.12 years of follow-up, the incidence of CVD was 5.87%, 10.13%, and 10.90% in the no-exposed group, uterine famine exposed group, and childhood famine exposed group, respectively. Compared with participants in the no-exposed group, the CVD risk and stroke risk increased in participants in the uterine famine exposed group (for CVD, HR: 1.32, 95% CI 1.04–1.67; for stroke, HR:1.37, 95% CI 1.05–1.79), but not in childhood famine exposed group. However, the increased CVD risks were only observed in females or smokers. No increased MI risks were observed for participants in the uterine famine exposed group or childhood famine exposed group.ConclusionsOur findings suggested that exposure to famine during uterine life might increase the risk of CVD in adulthood in participants with MS.

Association between Seafood Intake and Cardiovascular Disease in South Korean Adults: A Community-Based Prospective Cohort Study.

Cardiovascular disease (CVD) is the most common non-communicable diseases causing 18.6 million deaths worldwide. Several studies have revealed that seafood consumption has a protective effect against CVD. This study investigated the correlation between CVD and seafood intake based on a 10-year follow-up of the Korean Genome and Epidemiology Study (KoGES). The study population, which included 6565 adults age, 55.65 (±8.68), was divided into seafood intake-based tertiles. CVD included myocardial infarction, coronary artery disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease. At baseline, participants with low seafood intake also had low eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes. Prospectively, hazard ratios (HRs) with 95% confidence intervals (CIs) for CVD were analyzed using Cox proportional hazards regression models. Seafood intake exhibited a significantly inverse relationship with the cumulative CVD incidence over 10 years regardless of sex (women: log-rank test p &lt; 0.001 and men: log-rank test p &lt; 0.0401). The longitudinal association of low seafood intake with the CVD risk was significantly stronger in female participants after adjusting for confounding variables (HR (95% confidence interval (CI)) = 0.718 (0.519-0.993) p-trend = 0.043). These results suggested that seafood consumption potentially ameliorates CVD risk in middle-aged adults.

Redefining Cardiovascular Health to Include Sleep: Prospective Associations With Cardiovascular Disease in the MESA Sleep Study.

Background Although sufficient and healthy sleep is inversely associated with cardiovascular disease (CVD) and its risk factors, the American Heart Association's Life's Simple 7 (LS7), as a measure of cardiovascular health (CVH), did not include sleep. We evaluated an expanded measure of CVH that includes sleep as an eighth metric in relation to CVD risk. Methods and Results The analytic sample consisted of MESA (Multi-Ethnic Study of Atherosclerosis) Sleep Study participants who had complete data on sleep characteristics from overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and the outcome. We computed the LS7 score and 4 iterations of a new CVH score: score 1 included sleep duration, score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea), scores 3 and 4 included sleep characteristics associated with CVD in MESA (score 3: sleep duration and efficiency, daytime sleepiness, and obstructive sleep apnea; score 4: score 3+sleep regularity). Multivariable-adjusted logistic and Cox proportional hazards models evaluated associations of the LS7 and CVH scores 1 to 4 with CVD prevalence and incidence. Among 1920 participants (mean age: 69±9 years; 54% female), there were 95 prevalent CVD events and 93 incident cases (mean follow-up, 4.4 years). Those in the highest versus lowest tertile of the LS7 score and CVH scores 1 to 4 had up to 80% lower odds of prevalent CVD. The LS7 score was not significantly associated with CVD incidence (hazard ratio, 0.62 [95% CI, 0.37-1.04]). Those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratio, 0.57 [95% CI, 0.33-0.97]; and hazard ratio, 0.53 [95% CI, 0.32-0.89]), respectively. Conclusions CVH scores that include sleep health predicted CVD risk in older US adults. The incorporation of sleep as a CVH metric, akin to other health behaviors, may enhance CVD primordial and primary prevention efforts. Findings warrant confirmation in larger cohorts over longer follow-up.