Association Of Cardiovascular Risk Research Articles

Cardiovascular Risk in Pediatric Renal Transplant Recipients.

The survival of pediatric chronic kidney disease (CKD) patients has improved in recent decades due to advances in dialysis and transplantation. However, cardiovascular disease (CVD) emerges as the main cause of mortality in patients with CKD. To estimate cardiovascular risk in children with CKD at least 1 year after kidney transplantation. In addition, the possible association of cardiovascular risk with classic biochemical markers and potential new markers of this outcome was investigated. An observational ambidirectional (retrospective capture of risk factors and prospective study of outcomes) research including 75 patients who underwent renal transplant between 2003 and 2013 with postoperative follow-up of at least 1 year was conducted. The outcome variables adopted were the LV mass Z-score and the presence of coronary calcification on computed tomography using calcium Agatston score. Only one patient had an elevated calcium score, and three children (4%) had an LV mass Z-score ≥ 2.0. After multivariable analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass. The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Nevertheless, long-term follow-up of these patients is recommended, given the limited duration of kidney function provided by transplantation and the high likelihood of further dialysis and kidney transplants being required in these children.

Association of platelet aggregation to amyloid and tau PET in the Framingham Heart Study

AbstractBackgroundPlatelets are key mediators of inflammation and vascular dysfunction. Prior work highlighted a role of platelet function in Ab and tau dynamics, and dementia risk. We hypothesized that platelet aggregation may associate with amyloid and tau brain levels in middled age people at risk of cardiovascular disease.MethodWe examined cross sectional associations of platelet aggregation with brain amyloid and tau PET levels (11C‐labeled Pittsburgh Compound‐B (PiB) and tau (18F‐Flortaucipir (FTP)) in middle aged cognitively normal participants at the Framingham Heart Study (FHS) Gen3 Cohort. Platelet aggregation was measured by light transmission aggregometry. The response to 0.98uM ADP stimulation was primarily evaluated followed by additional agonists and stimulation doses for sensitivity analysis. The associations were explored in multivariate regression models adjusted for age, age squared, sex, the time from blood to PET examination, and PET camera used.ResultThe final study sample included 356 participants (median [Q1,Q3] age, 55 [49, 61]; 51% women) of which 82 (23%) were on preventive platelet modifying treatments (PPT) (Table 1). We found significant interaction between PPT and platelet aggregation in their association with amyloid and tau PET levels, motivating a stratified analysis by the use or not of PPT. The platelet aggregation response was not associated with PiB or FTP retention in non‐PPT users (n = 274) (Table 2). In PPT users, the platelet aggregation response was positively associated with amyloid levels in the precuneus (β±SE: 0.36±0.14, P<0.05), and tau levels in the rhinal (β±SE: 0.49±0.15, P<0.01) and temporal regions (β±SE: 0.39±0.17, P<0.05).ConclusionOur results indicate that platelet aggregation is not associated with amyloid and tau PET levels in the general population. In people who are on PPT for primary prevention of CVD, platelet aggregation associates with amyloid and tau PET in Alzheimer’s disease (AD) relevant brain regions. This result reinforces the need for further examining the mediator role of platelet aggregation in the association of cardiovascular risk and AD.

Food consumption frequency in schoolaged adolescents and its cardiovascular risk association

Childhood and adolescence are the life stages where eating habits related to the development of cardiovascular risk factors are usually established. To classify cardiovascular risk in school adolescents from Villavicencio (Colombia) and, additionally, to estimate its association with food intake frequency according to food kind. This is an analytical cross-sectional study developed in 1,504 adolescents of 13 to 17 years of age schooling in Villavicencio. We evaluated the cardiovascular risk according to the model proposed by Rodríguez-Soriano and Sanjurjo, and the food intake frequency with a structured survey. We used a binomial regression model to estimate the relationship between cardiovascular risk and food intake frequency. The mean age of the participants was 14.9 ± 0,07 years; 61.9% were women, and 80.6% came from schools located in urban areas. According to the cardiovascular risk classification, 34.5% of adolescents had a high cardiovascular risk, while 25.4% had intermediate risk. Men and those who consume more than two sugary drinks per day are those who presented a higher percentage of high cardiovascular risk (48.6% and 36.9%, respectively). Regression models showed that consumption of more than one sugary drink per day was associated with high levels of cardiovascular risk in adolescents (OR 1.27 95%CI 1.04-1.55). A high proportion of adolescents have medium and high cardiovascular risk; additionally, the consumption ofsugary drinks showed its association with cardiovascular risk.

Lipid Effects of Experimental Oophorectomy and Cardiovascular Risk Association

In view of the controversy between hormonal replacement in postmenopausal women and decreased cardiovascular morbidity and mortality, and the effects of estrogens associated with progesterones, or progesterone alone, we developed a protocol to evaluate the repercussions of hormone therapy with progesterone in oophorectomized rabbits submitted to atherogenic diet, on the development of atherosclerotic lesions induced in animals. Forty New Zealand rabbits were oophorectomized and divided into three groups. After 90 days, when the animals were sacrificed and the lesions that developed in the aorta and coronary arteries were evaluated. The results showed an increase in serum cholesterol in the four groups of animals. In groups II, III and IV, there was an increase of approximately fifteen times the baseline values, with no significant differences between these groups observed in 5 time courses. Regarding triglyceride levels, we found that group III showed a significant increase in values in Time 4, but this difference was not verified in Time 5. When quantitatively analyzing the area occupied by the lesion, we found that there were no statistically significant differences between the groups submitted to the atherogenic diet, observing that the coronary arteries presented a lower number of compromised arteries

Assessment and Mitigation of Cardiovascular Risk for Prostate Cancer Patients: A Review of the Evidence.

Background Cardiovascular disease (CVD) is a common comorbidity in patients with prostate cancer. In this review, we summarize the published literature on the association of cardiovascular risk with androgen deprivation therapy (ADT) treatment and explore the potential differences between the gonadotropin-releasing hormone (GnRH) agonists and antagonists and the molecular mechanisms that may be involved. We also provide a practical outlook on the identification of underlying CV risk and explore the different stratification tools available. Results While not definitive, the current evidence suggests that GnRH antagonists may be associated with lower rates of certain CV events vs agonists, particularly in patients with preexisting CVD. Risk reduction strategies such as lifestyle advice, consideration of ADT modality, and comedications may help to reduce CV risk factors and improve outcomes in prostate cancer patients receiving ADT. Conclusions Given all the data that is currently available, identification of baseline CV risk factors may be key to risk mitigation in patients with prostate cancer receiving ADT.

Associations of cardiovascular risk with circulating peptides related to hypertensive disorders of pregnancy.

We previously identified seven peptides in serum that are associated with hypertensive disorders of pregnancy (HDP). However, the significance of these peptides in the general population is unknown. The aim of this study was to clarify the relationships of HDP-associated peptides with hypertension and other cardiovascular risks in adult men. We investigated the relationships of peptide levels with cardiovascular risk factors, including adiposity, blood pressure, blood lipids and glycemic status, in men (mean age: 46.4 years) who were receiving annual health checkups at their workplace. The concentrations of the abovementioned seven peptides in serum were measured simultaneously using a mass spectrometer. Among the seven peptides, only a peptide with m/z 2091 (P-2091) derived from fibrinogen-α showed a significant correlation with diastolic blood pressure (Spearman's rank correlation coefficient [r], -0.446). Another peptide with m/z 2378 (P-2378) originating from complement component 4 showed a significant positive correlation with body mass index (r, 0.273) and a significant inverse correlation with HDL cholesterol (r, -0.336). In addition, a peptide with m/z 3156 (P-3156) derived from an inter-α-trypsin inhibitor showed significant inverse correlations with body mass index (r, -0.258) and triglycerides (r, -0.334). There was no significant correlation of the levels of any of the seven peptides with hemoglobin A1c. Among the seven peptides related to HDP, P-2091, P-2378 and P-3156 were inversely associated with diastolic blood pressure, HDL cholesterol and triglycerides, respectively. Therefore, these peptides are possible biomarkers for discriminating cardiovascular risk in a general population.

Association of cardiovascular risk and sex with cortical tau deposition in cognitively normal and at‐risk Alzheimer’s subjects

AbstractBackgroundEpidemiological data shows co‐incidence of cardiovascular (CV) disease and Alzheimer’s disease (AD), however the relationship between CV risk and specific AD biomarkers is not clear. Both CV disease and AD affect men and women differently. Here, we investigated the relationship between CV risk and cortical tau deposition in two regions, the entorhinal cortex (ETC) and the inferior temporal cortex (ITC). We hypothesised that high CV risk will be associated with increased cortical tau deposition.MethodCross‐sectional data of 197 subjects (mean age 78.4, 113 male, 84 female, 107 cognitively normal) who underwent AV‐1451 tau PET imaging were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. CV risk was calculated using the Framingham Heart Study 10‐year risk score for Cardiovascular Disease (FHS‐CVD) modified for age. Regional AV‐1451 uptake between the low‐risk (bottom 25% of the sample) and high‐risk (top 25%) subjects was compared.ResultHigh‐risk men showed significantly higher AV‐1451 uptake than their low‐risk counterparts in both the ETC (p=0.002) and in the ITC (p=0.02). After adjusting for age as a covariate, the difference remained significant for the ETC, but not the ITC. High‐risk and low‐risk women did not differ significantly in AV‐1451 uptake in neither of the regions studied.ConclusionThe results show that high CV risk is associated with increased cortical tau deposition in men, but not in women. These findings highlight the sex differences in AD trajectory and the need for stratification of subjects by sex in clinical trials.

Cardiovascular and skeletal safety of zoledronic acid in osteoporosis observational, matched cohort study using Danish and Swedish health registries.

This observational safety study used national registers to compare the real world cardiovascular and skeletal safety of zoledronic acid (ZA) against oral bisphosphonates (oBP) and untreated population controls. Propensity score matched cohort study in Sweden and Denmark. Matched cohort 1 included 8739 ZA users and 25,577 oBP users while matched cohort 2 included 8731 ZA users and 25,924 untreated subjects. In comparison to oBP users, heart failure risk was higher in ZA users, with an adjusted HR (adj) (95%CI) of 1.17 (1.04;1.32) and a higher all-cause mortality (adj HR 1.24 (1.15; 1.34)), however, there was no increased risk of cardiovascular mortality. In the comparison to untreated subjects, ZA users showed a higher risk of atrial fibrillation, adj HR 1.18 (1.05;1.32), arrhythmias adj HR 1.18 (1.06;1.31), and heart failure, adj HR 1.38 (1.24;1.54). Cardiovascular mortality was lower in ZA users (adj HR 0.87 (0.77; 0.98)) and risk of adverse skeletal outcomes was significantly higher, reflecting more severe osteoporosis in these patients. There was no association of cardiovascular risk with increasing exposure time. Sensitivity analyses produced similar findings with no substantial changes in event rates. We noted an increased risk of heart failure, fractures and death among ZA users compared with oral BP. The risk of cardiovascular and skeletal outcomes was higher in ZA users than in matched population controls, but there was no increase in cardiovascular mortality in ZA users compared to oral BP or untreated controls. Despite propensity score matching, it is not possible to determine with certainty whether the increased risk of cardiovascular outcomes is consistent with a true drug effect or higher baseline risk in patients who begin ZA treatment.

In COPD, new use of long-acting bronchodilators was linked to CV events at ≤30 days, but not >30 days.

Source Citation Wang MT, Liou JT, Lin CW, et al. Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: a nested case–co...

Association of Cardiovascular Risk With Inhaled Long-Acting Bronchodilators in Patients With Chronic Obstructive Pulmonary Disease

The associations between cardiovascular disease (CVD) and inhaled long-acting β2-agonists (LABAs) or long-acting antimuscarinic antagonists (LAMAs) in chronic obstructive pulmonary disease (COPD) are greatly debated. Pivotal and relevant randomized clinical trials included prior LABA or LAMA users and excluded patients with baseline CVD; therefore, cardiovascular events arising from first-time LABA or LAMA use, if any, could not be observed. There is an urgent need to examine whether new use of and duration since initiating LABAs and LAMAs could act as important determinants of cardiovascular events. To investigate risk of CVD associated with LABAs and LAMAs, focusing on the initiation and duration of LABA and LAMA therapies. This nested case-control study included 284 220 LABA-LAMA-naïve patients with COPD at least 40 years old (mean age, 71.4 years; 68.9% men), retrieved from the Taiwan National Health Insurance Research Database for health care claims from 2007 to 2011. LABA or LAMA use was measured in the year preceding the event or index date, stratified by duration since initiation of LABA or LAMA treatment, new and prevalent users, concomitant COPD medications, and individual agents. Cases with inpatient or emergency care visits for coronary artery disease, heart failure, ischemic stroke, or arrhythmia were identified and individually matched to 4 randomly selected controls. Conditional logistic regressions were performed to estimate odds ratios of CVD from LABA and LAMA treatment. During a mean follow-up of 2.0 years, 37 719 patients with CVD (mean age, 75.6 years; 71.6% men) and 146 139 matched controls (mean age, 75.2 years; 70.1% men) were identified. New LABA and LAMA use in COPD was associated with a 1.50-fold (95% CI, 1.35-1.67; P < .001) and a 1.52-fold (95% CI, 1.28-1.80; P < .001) increased cardiovascular risk within 30 days of initiation, respectively, whereas the risk was absent, or even reduced with prevalent use. Individual LABA agents, LAMA dosage forms, and concomitant COPD regimens did not differ in the CVD risks. The risk persisted in an alternative case-crossover study and remained across subgroups without CVD history or prior exacerbations. New initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations.

Metabolic syndrome and cardiovascular disease risk assessment among human immunodeficiency virus-infected individuals on antiretroviral therapy.

Background:The association of cardiovascular risk with first-line antiretroviral therapy (ART) in Indians has been a matter of concern with the background of a high risk in South Asians.Aims:This study aimed to compare metabolic syndrome and its components, dyslipidemia, insulin resistance, and cardiovascular risk among patients on first-line ART (Group 1) with age-matched, ART-naïve human immunodeficiency virus (HIV)-infected patients (Group 2) and normal controls (Group 3).Methods:Patients attending a tertiary care center in Mysore were enrolled in the study after obtaining informed consent and controls were chosen from relatives of patients.Results:The total number of patients enrolled in the study was 217 (males 111; females 106), and the mean age of these patients was 34.1 ± 7.4 years. The number of patients in Group 1 (HIV+, ART experienced) was 76; in Group 2 (HIV+, ART naïve) was 71, and in Group 3 (HIV−) was 70. There was no statistically significant difference in the prevalence of metabolic syndrome between the three groups. On comparing the components of metabolic syndrome, serum triglycerides (mg/dl) were significantly higher in the ART group (Group 1: 149.5 [interquartile range (IQR): 84–187], Group 2: 108 [IQR: 74–152], and Group 3: 141.5 [IQR: 89–192]; P = 0.014) and serum high-density lipoprotein cholesterol was higher in HIV-uninfected individuals (Group 1: 37.5 ± 11.83, Group 2: 31.5 ± 12.23, and Group 3: 40.1 ± 12.09; P = 0.0002). There was no association between metabolic syndrome, duration of HIV, and type of first-line ART. Total and low-density lipoprotein (LDL) cholesterol were significantly higher in the ART group. Homeostatic model assessment and Framingham scores did not reveal any significant difference across the three groups.Conclusion:HIV-infected individuals on ART had higher levels of triglycerides, LDL, and total cholesterol, but no increased cardiovascular risk compared to other groups.

Cohort Differences in the Association of Cardiovascular Risk and Cognitive Aging

Abstract. Aim: To investigate birth cohort differences in associations between cardiovascular risk and fluid cognition between the age of 70 and 79. Method: Data were drawn from representative population-based cohort samples (H70), born 1901–1902, 1906–1907, and 1930, measured at ages 70, 75, and 79 on fluid cognitive measures (spatial ability and logical reasoning). The Framingham Risk Score (FRS), derived from office-based nonlaboratory predictors (age, sex, systolic blood pressure, BMI, smoking, diabetes status), was used to measure cardiovascular risk. Multiple-group latent growth curve models were fitted to the data. Findings: Estimates revealed small associations between the FRS and fluid cognition. These associations were slightly reduced in the 1930 cohort. Conclusion: Findings suggest diminishing adverse effects of cardiovascular risk on cognitive aging in cohorts born later.

Abstract P370: Nocturnal Blood Pressure Fall on Ambulatory Monitoring in a Cohort Data of Elderly Subjecsts

Introduction: The use of Ambulatory Blood Pressure Monitoring has offered parameters that directly support stratification and independent association of cardiovascular risk (CV), especially in the elderly. Objective: To evaluate systolic (SBP) and diastolic (DBP) patient’s blood pressure (BP) on 24-hour, daytime and night time periods, pulse pressure (PP) and systolic and diastolic nocturnal drop in a population of elderly referred to be clinically healthy. Method: In a cohort of 1652 individuals over 60 years of age, both genders, we selected 434 subjects with no prior history of CV disease and off CV medications. Of these, 242 (56%) had normal and 192 (44%) had elevated mean 24-hour BP (G2), being 68 with isolated systolic hypertension (G2A) and 124 with systolic and diastolic hypertension (G2B). Analysis of variance was applied for a comparative study between groups, assuming a significance level of p less than 0.05. Results: Mean 24-hour, daytime and night time SBP in G1 were 118.94 ± 7.2, 122.27 ± 3.0, 110.23 ± 4.1 mmHg in men and 117.05 ± 6.3, 120, 46 ± 2.4 and 107.57 ± 3.4 mmHg in women (p = 0.06). Mean DBP values in the same periods were, respectively, 67.66 ± 6.62, 70.61 ± 5.3 and 60.24 ± 2.4 mmHg in men and 67.94 ± 5.2, 70.70 ± 5, 2 and 60.57 ± 5.1 mmHg in women (p = 0.08). Statistical analysis showed no difference for PP values between genders in different periods evaluated. In G2, there was a significant difference between subgroups A and B for all parameters, with mean 24-hour BP being 137,18x71,85 in G2A and 142,67x86,33 in G2B, p 0.003 SBP and 0.001 DBP, and 24-hour PP 65.32 and 56.33 mmHg, respectively (P 0.001), with no significant difference between genders. Regarding mean systolic and diastolic nocturnal drop, we observed values in G1 10,06 ± 7,07 and 14,37 ± 8,18, in G2A 5,24 ± 10,2 and 9,73 ± 9,8 and in G2B 8,93 ± 6.47 and 13.36 ± 6.5 mmHg, respectively; that is, lower values in G2A compared to G1 and G2B (p 0.001 and p 0.033), with G1 and G2B with no significant difference. Conclusions: Since the nocturnal drop pattern is the most consistent predictor of CV outcome, we have confirmed in our findings, previous literature data, which shown reduced nocturnal BP falls in the elderly population as a marker of BP elevation itself, after adjusting for age, gender and comorbidities.

Association of cardiovascular risk using non-linear heart rate variability measures with the framingham risk score in a rural population

Cardiovascular risk can be calculated using the Framingham cardiovascular disease (CVD) risk score and provides a risk stratification from mild to very high CVD risk percentage over 10 years. This equation represents a complex interaction between age, gender, cholesterol status, blood pressure, diabetes status, and smoking. Heart rate variability (HRV) is a measure of how the autonomic nervous system (ANS) modulates the heart rate. HRV measures are sensitive to age, gender, disease status such as diabetes and hypertension and processes leading to atherosclerosis. We investigated whether HRV measures are a suitable, simple, noninvasive alternative to differentiate between the four main Framingham associated CVD risk categories. In this study we applied the tone-entropy (T-E) algorithm and complex correlation measure (CCM) for analysis of HRV obtained from 20 min. ECG recordings and correlated the HRV score with the stratification results using the Framingham risk equation. Both entropy and CCM had significant analysis of variance (ANOVA) results [F(172, 3) = 9.51; <0.0001]. Bonferroni post hoc analysis indicated a significant difference between mild, high and very high cardiac risk groups applying tone-entropy (p < 0.01). CCM detected a difference in temporal dynamics of the RR intervals between the mild and very high CVD risk groups (p < 0.01). Our results indicate a good agreement between the T-E and CCM algorithm and the Framingham CVD risk score, suggesting that this algorithm may be of use for initial screening of cardiovascular risk as it is noninvasive, economical and easy to use in clinical practice.

22 - The association of cardiovascular risk and high body mass index in adolescents is influenced by waist circumference

22 - The association of cardiovascular risk and high body mass index in adolescents is influenced by waist circumference

Spotlights on Ambulatory Measures of Arterial Stiffness

Spotlights on Ambulatory Measures of Arterial Stiffness