Adverse Cardiovascular Risk Factor Profile Research Articles

Type 2 diabetes in families and diabetes prevention

Type 2 diabetes frequently clusters in families. Non-diabetic first-degree relatives (offspring and siblings) of patients with type 2 diabetes have a three-fold increased lifetime risk of developing diabetes compared with the background population. This increased diabetes risk results from the combined effects of shared genetic and lifestyle factors. Extensive studies of non-diabetic relatives of type 2 diabetic families show that impaired insulin secretion, insulin resistance and an adverse cardiovascular risk factor profile exist well before the development of frank diabetes. Despite this well-documented adverse metabolic predisposition, patients with type 2 diabetes and their non-diabetic relatives generally have a limited understanding of the risks. Several large-scale studies, such as the Finnish Diabetes Prevention and Diabetes Prevention Program studies, indicate unequivocally that lifestyle modification through dietary change and exercise can dramatically decrease risk of progression to diabetes in high-risk subjects. However, such individuals pursue lifestyle changes only if they understand their own risk of developing diabetes. Further work is therefore needed to investigate and develop optimal ways of improving knowledge of diabetes risk in families of patients with type 2 diabetes, so that they can appreciate the potential benefits of diabetes prevention strategies.

Cardiovascular comorbidity and cardiovascular risk factors in patients with chronic inflammatory skin diseases: A case-control study utilising a population-based administrative database

Background: : Psoriasis (PSO) and atopic eczema (AE) are chronic inflammatory disorders that primarily affect the skin. Data on cardiovascular comorbidity in PSO is scarce, and studies on the association of cardiovascular disease/cardiovascular risk factors and AE are missing. Methods: We performed two separate case-control studies for PSO and AE utilising an administrative health care database including approximately 250,000 individuals from Germany. Cases with AE (n=6,296) and cases with PSO (n=3,156) were individually-matched (1:1) to controls with the same age and sex. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated based on the observed prevalences of cardiovascular morbidity among cases and controls. Results: Patients with AE had a higher risk of obesity (OR,95%CI 1.24, 1.07-1.44). None of the other cardiovascular risk factors or diseases studied was associated with AE. PSO was significantly associated with hypertension (OR,95%CI 1.45, 1.27-1.66), diabetes mellitus type-2 (OR,95%CI 1.35, 1.13-1.61), obesity (OR,95%CI 1.58, 1.34-1.85), dyslipidemia (OR,95%CI 1.42, 1.14-1.77), and atherosclerosis (OR,95%CI 1.81, 1.37-2.41). Despite their unfavorable cardiovascular risk factor profile, patients with PSO were not at increased risk of adverse cardiovascular events (myocardial infarction OR,95%CI 1.14, 0.74-1.77; cerebral apoplexy OR,95%CI 0.94, 0.57-1.55). Conclusions: Chronic inflammation due to AE does not appear to cause adverse cardiovascular comorbidities. In contrast, PSO is associated with an adverse cardiovascular risk factor profile, but this does not necessarily appear to translate into a higher risk for cardiovascular events. This study does not rule out that specific treatments for AE or PSO modify the risk of cardiovascular disease.

Deprivation status and mid-term change in blood pressure, total cholesterol and smoking status in middle life: a cohort study

Individuals of lower socioeconomic status have an adverse cardiovascular disease risk factor profile. We examined whether deprivation status influences within-individual change over time in blood pressure (BP), cholesterol and smoking status during middle life. Records of participants of a primary care-based cardiovascular disease risk factor screening programme who were aged 35-55 years and had a first screening episode between 1989 and 1993 and a subsequent screening episode, were analysed. Deprivation status was defined using quintiles of the Townsend score. Using regression, mean annual change in BP, and total cholesterol was calculated for each deprivation group; and the effect of deprivation group status was examined. The probability of quitting smoking was also examined by deprivation group. Of all participants, 13,812 (72.1%) men and 16 932 (77.0%) women had complete follow-up (i.e. two screening episodes). Mean annual increase in systolic BP was significantly greater with increasing deprivation group [by +0.24 and +0.28 mmHg/incremental deprivation group in men and women, respectively (95% confidence interval: +0.09 to +0.39 men, and +0.13 to +0.42 women)]. Deprivation status did not influence change in cholesterol (P=0.620, men, P=0.289, women). The probability of quitting smoking was significantly greater with increasing deprivation group in women [odds ratio 1.06 (95% confidence interval: 1.01-1.12)], but no effect was observed in men (P=0.389). The results are suggestive of a 'mixed' picture of widening (e.g. systolic and diastolic BP) as well as narrowing (e.g. smoking in women) socioeconomic inequalities in cardiovascular risk factor inequalities.

Antipsychotics and risk of first‐time hospitalization for myocardial infarction: a population‐based case–control study

Use of antipsychotics has been linked with an adverse cardiovascular risk factor profile and an increased risk of dysrhythmia and sudden cardiac death. However, detailed data on the association between use of antipsychotics and development of atherosclerotic disease are limited. To examine risk of hospitalization for myocardial infarction (MI) amongst users of antipsychotics compared with non-users. A population-based case-control study using data from hospital discharge registries in the counties of North Jutland, Viborg and Aarhus, Denmark, and the Danish Civil Registration System. We identified 21,377 cases of first-time hospitalization for MI and 106,885 sex- and age-matched non-MI population controls in the period 1992-2004. All prescriptions for antipsychotics filled prior to the date of admission for MI were retrieved from population-based prescription databases. We used conditional logistic regression to adjust for a wide range of covariates. Current users of atypical [adjusted relative risk: 0.98, 95% confidence interval (CI): 0.88-1.09] and typical antipsychotics (adjusted relative risk: 0.99, 95% CI: 0.96-1.03) had no increased overall risk of being admitted to hospital for MI when compared with non-users of antipsychotics. These findings were consistent in all examined subgroups. Further, we found no association between the cumulative dose of antipsychotics and the risk of hospitalization for MI. These findings do not support the hypothesis that use of antipsychotics and in particular atypical antipsychotics is associated with increased risk of MI.

Hypertension—A Treatable Component of the Cardiometabolic Syndrome: Challenges for the Primary Care Physician

Patients with the cardiometabolic syndrome (CMS) have an adverse cardiovascular risk factor profile, placing them at increased risk of stroke, coronary artery disease, chronic kidney disease, and type 2 diabetes mellitus. Although no specific treatments for CMS are available per se, prompt recognition and treatment of the individual components of the condition can prevent or delay the development of comorbidities. Primary care physicians are ideally positioned to identify patients with CMS and implement early intervention strategies. Hypertension contributes to many complications of CMS, and rigorous blood pressure control will help to delay or prevent end-organ vascular damage. Achieving blood pressure control to current guideline standards should be eagerly sought in the majority of patients through a combination of lifestyle modifications and appropriate pharmacologic therapy. Antihypertensive drug choice should be personalized, taking into account the CMS determinants present and any compelling indications for specific agents. As an initial approach, a thiazide diuretic is suitable for most cases of uncomplicated hypertension, although many patients will require additional antihypertensives from other classes to achieve their blood pressure goal. It is predicted that, due to the increase in unhealthy lifestyles, the prevalence of CMS will rise in the coming years. Therefore, by meeting the challenge of attaining and maintaining blood pressure control in patients with CMS, primary care physicians have the unique opportunity to markedly improve the health of the nation.

Sex Differences in Coagulation and Fibrinolysis in Subjects with Coronary Artery Disease

Women with coronary artery disease (CAD) have a prognosis at least as bad and possibly worse than men. Differences in classical risk factors do not fully account for these findings and there is evidence that circulating levels of haemostatic factors may predict CAD risk. In this study sex differences in haemostatic risk factors were examined in relation to coronary stenosis. 609 (420 men, 69%) subjects admitted for coronary angiography for suspected CAD were recruited. Levels of Factor VII:C (FVII:C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF) were estimated in 296 subjects from one centre. Of these, women (n = 107) had higher levels of FVII:C (134% vs 117%, p < 0.0005), and fibrinogen (3.4 g/l vs 3.2 g/l p = 0.01) than men (n = 189) and these differences remained after adjusting for other covariates. In subjects with angiographically significant atheroma these differences in haemostatic factors (n = 50 for women vs n = 147 for men) were exaggerated, (FVII:C 139% vs 117, p < 0.0001, fibrinogen 3.7 g/l vs 3.3 g/l p = 0.003), PAI-1 (26.2 ng/ml vs 19.7 ng/ml, p = 0.02) with a trend towards higher levels of vWF in the women. Women with significant atheroma at angiography (n = 50) had higher levels of PAI-1 (25.0 ng/ml vs 13.4 ng/ml p < 0.0001) and vWF (1.25 IU/ml vs 1.06 IU/ml, p = 0.02) and a trend towards higher levels of both fibrinogen and FVII:C than women with normal or in significant coronary vessel disease (n = 57). Elevated circulating levels of PAI-1, vWF, fibrinogen and FVII:C in women with angiographically proven CAD may contribute to an adverse cardiovascular risk factor profile and the poorer prognosis in females than male patients with proven coronary artery disease.

Longitudinal Changes in Cardiovascular Risk From Childhood to Young Adulthood in Offspring of Parents With Coronary Artery Disease

Although the association between parental coronary artery disease (CAD) and its risk factors in the offspring is known, the timing and the course of development of risk factors from childhood to adulthood in the offspring is not known. To examine the association between parental CAD and longitudinal changes in risk factor profile from childhood to young adulthood in offspring. Cohort study. Bogalusa, La, a semirural, biracial community. Individuals with clinically verified parental history of CAD (n=271) vs those without such a history (n = 1253) Mean age at first CAD event was 50 years for fathers and 52 years for mothers. Body mass index, subscapular skinfolds, blood pressure, and triglyceride, cholesterol (total, very low-density lipoprotein [VLDL-C], low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C] cholesterols), glucose, and insulin levels. The offspring of parents with CAD were consistently overweight beginning in childhood. Their levels of total serum cholesterol, LDL-C, plasma glucose, and insulin became significantly higher at older ages, because of a higher rate of increase in these risk factors over time. In adulthood, the offspring with a positive parental history had a higher prevalence of obesity (body mass index >85th percentile in the National Health and Nutrition Examination Survey I, 35% vs 26%, P=.01), elevated total cholesterol (>6.2 mmol/L [240 mg/dL], 8.4% vs 4.8%, P=.05) and LDL-C levels (>4.1 mmol/L [160 mg/dL], 12.4% vs 4.7%, P=.05), and hyperglycemia (glucose, >6.6 mmol/L, 2.7% vs 0.4%, P<.001), as well as a higher coexistence of these conditions (P=.01). Further, the prevalence of dyslipidemia, either involving only LDL-C or LDL-C in combination with HDL-C or triglycerides or both, was significantly higher in the adult offspring with parental CAD. Offspring of parents with early CAD were overweight beginning in childhood and developed an adverse cardiovascular risk factor profile at an increased rate. These observations have important implications for prevention and intervention.

Cardiovascular risk factor profile in subjects with familial predisposition to myocardial infarction in Denmark.

STUDY OBJECTIVES: To identify possible modifiable mediators of familial predisposition to myocardial infarction (MI) by assessing the risk factor profile in individuals without MI in relation to parental occurrence of...

Abdominal Fat Distribution and Insulin Levels Only Partially Explain Adverse Cardiovascular Risk Profile in Asian Indians

Asian Indians show an increased risk of non-insulin-dependent diabetes mellitus (NIDDM) and coronary heart disease, together with adverse fat distribution and hyperinsulinaemia relative to other ethnic groups. Using population-based data, we investigated the question of whether the adverse fat distribution observed in Indians can be explained by differences in behavioural risk factor levels. We have examined the question of whether ethnic differences in fat distribution are responsible for the unfavourable risk factor profile of Indians. Fat distribution (waist: hip ratio) was compared in population-based samples of Asian Indian (n = 4394), Creole (n = 1746), and Chinese (n = 425) Mauritians, after controlling for body mass index and other factors. The contribution of this ratio to ethnic differences in cardiovascular disease risk factors and the role of fasting insulin concentrations were also determined. Indian men had the highest mean waist: hip ratio, despite having the lowest body mass index. In Indian women the mean waist: hip ratio and body mass index were intermediate between those of Chinese and Creole women. Indians of both sexes had low levels of high-density lipoprotein (HDL) cholesterol and HDL: total cholesterol compared with Creoles or Chinese, whereas triglycerides levels were highest in Indian men but intermediate in Indian women. Mean fasting and 2 h insulin concentrations were not consistently highest in the Indian subgroups. Blood pressure and serum urate levels were lowest in Indians of both sexes and Indian women also had lower total cholesterol concentrations than either Creoles or Chinese. The elevated waist: hip ratio in Indians was not explained by differences in physical activity, cigarette smoking, or alcohol consumption and the differences in this ratio (and insulin levels) did not explain the observed ethnic differences in metabolic parameters. The susceptibility of Indians to abdominal obesity contributed to the less desirable levels of some, but not all, cardiovascular risk factors. Ethnic differences in cardiovascular risk factors in Mauritians were not explained by differences in abdominal obesity, serum insulin or behavioural risk factors. These data suggest that it is over-simplistic to ascribe the adverse cardiovascular risk factor profile commonly observed in Asian Indians to a tendency to abdominal obesity.

Incidence and predictors of diabetes in Japanese-American men the Honolulu Heart Program

Reports on the incidence and predictors of diabetes in minority populations are infrequent. The 6-year cumulative incidence of diabetes between 1965 and 1974 was estimated among 7210 Japanese-American men aged 45 to 68 years who were enrolled in the Honolulu Heart Program and were free of clinically recognized diabetes at baseline. The incidence of “possible” diabetes (based on history, medication, or hospital diagnosis) was 12.8% and the incidence of “probable” diabetes (based on diabetic medication) was 5.7%. Estimates of incidence in subjects with a nonfasting glucose concentration less than 225 mg/dL 1 hour after a 50-g load were 9.7 and 4.0%, respectively. Multivariate adjusted odds ratios (ORs) for probable diabetes in all subjects comparing the upper quintile with the lower four quintiles combined for continuous variables indicated statistically significant direct associations with body mass index (OR, 1.69; 95% confidence interval (CI), 1.31 to 2.18), 1-hour postchallenge glucose level (OR, 5.79; 95% CI, 4.58 to 7.33), triglyceride levels (OR, 1.47; 95% CI, 1.14 to 1.91), systolic blood pressure (OR, 1.36; 95% CI, 1.05 to 1.76), and parental history of diabetes (OR, 1.73; 95% CI, 1.29 to 2.33), and an inverse association with physical activity (OR, 0.49; 95% CI, 0.34 to 0.72), using logistic regression models including these variables as well as age, subscapular/triceps skinfold ratio, and hematocrit simultaneously. Associations were similar but slightly weaker in men with glucose levels less than 225 mg/dL and in those who remained free of cardiovascular disease. When older men (55 to 68 years old) were compared with younger (45 to 54 years old) men, associations among the older group were stronger for body mass index, physical activity, and systolic blood pressure and they were weaker for glucose levels, triglyceride values, and parental diabetes. Results suggest that body mass index, physical inactivity, glucose level, and parental diabetes appear to be independent risk factors for diabetes, while triglyceride and systolic blood pressure levels may be markers for an adverse cardiovascular risk factor profile associated with diabetes and may reflect an insulin resistance syndrome.

Association between serum uric acid and some cardiovascular risk factors in a Chinese population

The association between serum uric acid concentration and some cardiovascular risk factors was examined in a working Hong Kong Chinese population (mean age 38 years), consisting of 910 men and 603 women. There was no significant age-related rise in serum uric acid concentration. Positive associations were found between serum uric acid concentration and body mass index, waist hip ratio, systolic and diastolic blood pressure, urea, creatinine, protein, glucose (fasting and 2 hours after 75 g oral glucose load), 2 hour insulin, triglycerides, and apolipoprotein B in men. Similar, but fewer, associations were seen in women, with the addition of a positive association with age. In both sexes, serum uric acid was negatively associated with high-density lipoprotein cholesterol. These findings complement the well-known clinical association between gout and cardiovascular and metabolic diseases, such as hypertension, hyperlipidaemia and diabetes mellitus, and suggest that serum uric acid may be a marker for the presence of an adverse cardiovascular risk factor profile.