Association Of Traditional Risk Factors Research Articles

Factores de riesgo para la enfermedad coronaria temprana en mujeres

Coronary disease is the leading cause of death in women, and consequently, identification of cardiovascular risk factors must be a priority. Recent studies have linked pregnancy disturbances and coronary disease, but this hypothesis has remained unproved in Hispanic women. The association of traditional risk factors and pregnancy disturbances with coronary heart disease was assessed in a sample of women with premature coronary disease. The case control study included only women <55 years old, who had undergone a coronary angiography. Two hundred women were included, 100 without and 100 with coronary disease, and with mean ages of 46.5±4.3 and 49.5±3.7 years, respectively. Logistic regression analysis was used to assess the relationship between risk factors and coronary disease. Crude and multivariate adjusted odds ratios with 95% confidence intervals were calculated. Univariate analysis showed an association between coronary disease and the past medical history of preeclampsia, premature delivery, low birth weight, diabetes, hypercholesterolemia and smoking habit. Logistic regression analysis showed an association of premature delivery (OR=6.0, 95%CI 2.3-15.0, p<0.01), hypercholesterolemia (OR=4.1, 95%CI 2.1-7.8, p<0.01) and smoking habit (OR=1.7, 95%Ci 0.9-3.2, p=0.08). The practice of regular physical activity was identified as a protection factor (OR=0.5, 95%CI 0.3-1.0, p=0.04). Pregnancy disturbances and traditional risk factors were related to an increased risk of coronary artery disease in a Hispanic population of women with premature coronary disease.

Multimarker Prediction of Coronary Heart Disease Risk: The Women's Health Initiative

The aim of this study was to investigate whether multiple biomarkers contribute to improved coronary heart disease (CHD) risk prediction in post-menopausal women compared with assessment using traditional risk factors (TRFs) only. The utility of newer biomarkers remains uncertain when added to predictive models using only TRFs for CHD risk assessment. The Women's Health Initiative Hormone Trials enrolled 27,347 post-menopausal women ages 50 to 79 years. Associations of TRFs and 18 biomarkers were assessed in a nested case-control study including 321 patients with CHD and 743 controls. Four prediction equations for 5-year CHD risk were compared: 2 Framingham risk score covariate models; a TRF model including statin treatment, hormone treatment, and cardiovascular disease history as well as the Framingham risk score covariates; and an additional biomarker model that additionally included the 5 significantly associated markers of the 18 tested (interleukin-6, d-dimer, coagulation factor VIII, von Willebrand factor, and homocysteine). The TRF model showed an improved C-statistic (0.729 vs. 0.699, p = 0.001) and net reclassification improvement (6.42%) compared with the Framingham risk score model. The additional biomarker model showed additional improvement in the C-statistic (0.751 vs. 0.729, p = 0.001) and net reclassification improvement (6.45%) compared with the TRF model. Predicted CHD risks on a continuous scale showed high agreement between the TRF and additional biomarker models (Spearman's coefficient = 0.918). Among the 18 biomarkers measured, C-reactive protein level did not significantly improve CHD prediction either alone or in combination with other biomarkers. Moderate improvement in CHD risk prediction was found when an 18-biomarker panel was added to predictive models using TRFs in post-menopausal women.

Relation of coronary artery plaque location to extent of coronary artery disease studied by computed tomographic angiography

Distal coronary artery disease (CAD) is less amenable to surgery or stenting compared with proximal disease. However, little is known about the epidemiology of distal versus proximal CAD. We determined the prevalence and factors associated with proximal, mid, and distally located plaque in the left anterior descending, left circumflex, and right coronary arteries in 418 subjects without prior CAD history who underwent coronary computed tomographic angiography for symptoms or stress test results. Clinical characteristics and coronary artery calcium (CAC) scores were also determined. Most subjects (88%) had plaque, but only 18% of plaques were associated with stenosis >50%. In subjects with single-vessel plaque, only 7% had distal plaque, whereas 75% had proximal plaque. With 3-vessel plaque, 70% had distal and 100% had proximal plaques. Of subjects with a single location of plaque along a vessel, most had proximal plaque (69%); isolated distal-vessel plaque was rare (2%). Distal plaque was dominantly found in association with both proximal and mid plaque (88%). After multivariable adjustment for demographics, traditional, and nontraditional risk factors, both increasing number of vessels with plaque and clinically significant CAC scores were independently associated with higher odds of distal plaque, whereas associations of traditional risk factors were weaker. Distal plaque was independently associated with stenosis > 50%. These data support the concept that early lesions are most often proximal and that CAC scoring may be a poor screening tool for detecting proximal disease. Furthermore, distal lesions are more associated with advanced disease than with traditional cardiovascular risk factors.

Comparison of Cardiovascular Risk Factors for High Brachial Pulse Pressure in Blacks Versus Whites (Charleston Heart Study, Evans County Study, NHANES I and II Studies)

We examined whether the risk factors for increased brachial pulse pressure (PP) are similar for blacks and whites. Many studies have reported the strong association of increased brachial PP and the prevalence of cardiovascular disease. Participants were from 4 major epidemiologic studies in the United States (26,083 subjects): Charleston Heart Study, Evans County Heart Study, the National Health and Nutrition Examination Survey (NHANES) I study, and the NHANES II study. At baseline, there was no history or clinical evidence of coronary heart disease (CHD). The CHD mortality as a function of brachial PP and the association of traditional risk factors for CHD with PP were analyzed for each of the 4 studies and for the 4 studies combined. Multiple regression analysis showed that the most significant predictors of high brachial PP are body mass index > or =30 kg/m(2) (regression coefficient 3.79, p <0.0001), diabetes mellitus (5.14, p <0.0001), serum total cholesterol > or =240 mg/dl (0.51, p <0.0157), age (0.60, p <0.0001), gender (-1.77, p <0.0001), and race (3.75, p <0.0001). In conclusion, the same risk factors for CHD (namely, increase in body mass index > or =30 kg/m(2), diabetes mellitus, hypercholesterolemia, and age) are significantly associated with high brachial PP for blacks and whites. These risk factors were stronger in whites compared with blacks. However, female gender and age variables were even more associated with brachial PP in blacks. Smoking was significant but not reflected in peripheral brachial PP as it is in aortic PP.

Association of Traditional Risk Factors With Cardiovascular Death Across 0 to 10, 10 to 20, and >20 Years Follow-Up in Men and Women

Previous studies have evaluated the strength of the association between traditional risk factors and cardiovascular disease (CVD) across varying lengths of follow-up in men. However, to our knowledge, little is known regarding the behavior of these risk factors across time in women. Thus, we sought to determine the association between traditional risk factors in men and women across follow-up periods of 0 to 10, 10 to 20, and >20 years. We studied 9,033 men and 7,575 women (ages 40 to 59 years) from 1967 to 1973 from the Chicago Heart Association Detection Project in Industry. Multivariable-adjusted Cox proportional hazard models were constructed to compare the hazard ratios (HRs) and 95% confidence intervals (CI) for CVD risk factors measured at baseline across different periods of follow-up (0 to 10, 10 to 20, and >20 years). In women, the HRs for smoking and diabetes mellitus were strongest at 0 to 10 years (HR 5.38, 95% CI 2.99 to 9.67 and 3.84, 95% CI 1.82 to 8.13, respectively) but decreased at >20 years (HR 1.71, 95% CI 1.48 to 1.97 and 1.60, 95% CI 1.10 to 2.32, respectively). In men, the HR (per 4 kg/m(2)) for body mass index appeared to increase (0 to 10 years, 1.01, 95% CI 0.90 to 1.14; >20 years, 1.20, 95% CI 1.13 to 1.28). In women, the association was similar across all follow-up periods. For both men and women, the HR for total serum cholesterol remained unchanged across the follow-up. In conclusion, we found gender differences in the patterns of association between risk factors measured at baseline and CVD death across different periods of follow-up. In women, the increased risk associated with both diabetes mellitus and smoking was most prominent in the early follow-up periods.

Site-specific atherosclerotic plaques in the carotid arteries of middle-aged women from southern Italy: associations with traditional risk factors and oxidation markers.

Studies on cardiovascular disease have preferentially involved men because of the lower frequency of the disease in preelderly women. The aim of this analysis was to examine, with the use of a standardized ultrasound protocol, a cohort of women to differentiate early atherosclerotic lesions in different carotid segments in relation to traditional (lipoprotein abnormalities, high blood pressure, cigarette smoking) and nontraditional (oxidation markers) cardiovascular risk factors. More than 5000 clinically healthy, middle-aged women (n=5062; age range, 30 to 69 years) living in the area of Naples in southern Italy participated in the Progetto Atena, a population-based study on the etiology of cardiovascular disease and cancer in the female population. A subsample of 310 participants underwent high-resolution B-mode ultrasound to assess intima-media thickness of common carotid artery and carotid bifurcation. Early atherosclerotic plaques (intima-media thickness >1.2 mm) were detected within the common carotid arteries in 37 women, in the carotid bifurcations in 77 women, and in both sites in 91 women. After age adjustment, common carotid plaques were found to be associated with higher systolic blood pressure (143 versus 138 mm Hg; P<0.05) and higher body mass index (29 versus 27 kg/m(2); P<0.01), while lesions at the carotid bifurcations were associated with higher LDL cholesterol (4.3 versus 3.8 mmol/L; P<0.01) and with smoking habit. Multivariate odds ratios for the presence of common carotid plaques were related to antibodies against oxidized LDL (odds ratio, 2.72; 95% CI, 1.46 to 5.07), and those for plaques at the bifurcation were related to lipid peroxides (odds ratio, 1.90; 95% CI, 1.04 to 3.47), and both relationships were independent of age, LDL cholesterol concentrations, body mass index, smoking habit, and systolic blood pressure. In a cohort of clinically healthy, middle-aged women, we found a site-specific association of traditional risk factors and oxidation markers with early atherosclerotic lesions in arterial segments differing in geometry, shear stress, extracellular matrix composition, and cell type populations.

Association of Traditional Risk Factors With Coronary Calcification in Persons With a Family History of Premature Coronary Heart Disease

BackgroundGenetic factors strongly influence the risk of coronary heart disease (CHD), but their contribution to variation in coronary atherosclerosis beyond that measured by traditional CHD risk factors is uncertain.MethodsWe recruited...

Short-Term All-Cause Mortality and Its Determinants in Elderly Male Populations in Finland, the Netherlands, and Italy: The FINE Study

Background.This study aims at identifying determinants of all-cause mortality in elderly populations of different countries.Methods.Men ages 65–84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; N=693), in the Netherlands (the town of Zutphen;N= 851), and in Italy (the rural areas of Crevalcore and Montegiorgio;N= 682). They were survivors of cohorts studied for 25 years within the Seven Countries Study with the addition of a subgroup of the same ages in the Netherlands.Results.Five-year death rates from all causes were higher in Finland (297 per 1000), intermediate in the Netherlands (231 per 1000), and lower in Italy (191 per 1000). Five-year all-cause mortality was studied in relation to measurements taken at entry (age, systolic and diastolic blood pressure, non-high-density lipoprotein (HDL) and HDL cholesterol, body mass index, heart rate, smoking habits, and presence of coronary heart disease manifestations). Univariate and multivariate analyses were performed (in the latter models, both linear and quadratic terms were used for most variables) with all-cause mortality as endpoint. Results suggested significant predictive power of age (direct relationship) and, in most cases, U-shaped relationships of risk factors to mortality. Non-HDL cholesterol showed significant relationships with mortality in Finland and the Netherlands, HDL cholesterol in all three countries, systolic blood pressure only in Finland, body mass index in Finland and the Netherlands, smoking habits only in Finland, and heart rate in none. Levels of risk factors associated with the lowest death rate in the pool of all countries were 183.3 mg/dl for non-HDL cholesterol, 59.8 for HDL cholesterol, 177.5 mm Hg for blood pressure, and 30.2 kg/m square for body mass index.Conclusions.In these elderly men the association of traditional risk factors with all-cause mortality is reduced, U-shaped, or even inverted. This is probably due to selection due to previous mortality, to co-morbidity, and to changes in homeostatic mechanisms.