Biological Cardiovascular Risk Factors Research Articles

Biological vascular age and its relationship with cardiovascular risk factors

Aim. To study of the relationship between cardiovascular risk factors and biological vascular age.Material and methods. The biological vascular age was estimated using models based on the arterial wall parameters. Using multiple logistic and linear regression, we studied the relationship between the biological vascular age and cardiovascular risk factors in 143 people without cardiovascular disease (CVD). Persons with a positive difference between the vascular and chronological age were assigned to the “old” vascular group, and persons with no or negative difference between the vascular and chronological age were assigned to the “young” vascular group.Results. Linear regression in the “young” vascular group showed an inverse relationship between the difference between the vascular and chronological age with the levels of low-density lipoprotein cholesterol (p=0,001; β±SE=-1,67±0,47), triglycerides (p=0,017; β±SE=-1,66±0,68), urea (p=0,025; β±SE=-0,89±0,39) and insulin resistance index (p=0,001; β±SE=-1,22±0,36). In the “old” vascular group, a direct relationship was found between the difference between the vascular and chronological age and central systolic blood pressure (p=0,015; β±SE=0,10±0,04). According to logistic regression, the likelihood of having “old” vessels increased by 1,23 times with an increase in blood glucose levels by 0,5 mmol/l (p=0,044; odds ratio (OR)=1,23; 95% confidence interval (CI): 1,011,51), the presence of hypertension (p=0,034; OR=3,11; 95% CI: 1,09-8,86) and type 2 diabetes (p=0,025; OR=3,61; 95% CI: 1,1711,09), as well as decreased by 2 times with an increase in high-density lipoprotein cholesterol by 0,3 mmol/l (p=0,003; OR=0,5; 95% CI: 0,32-0,79).Conclusion. The difference between the biological vascular age and chronological age is associated with traditional CVD risk factors.

P0186SERUM CYSTATIN C, INFLAMMATION AND AUTONOMIC DYSFUNCTION : A HIDDEN “MÉNAGE À TROIS”?

Abstract Background and Aims While being a GFR biomarker with comparable performance than serum creatinine (SCr), Serum cystatin C (ScysC) is a better predictor of morbi-mortalilty in the general as well as the CKD population. The mechanisms underlying the prognostic dimension of ScysC are unclear. Unlike SCr, ScysC is known to strongly and positively correlate to C Reactive Protein (CRP) and thereby could reflect autonomic nervous system (ANS) dysfunction. Transversal studies have underlined the association between the decline in autonomic nervous system (ANS) activity and all-cause mortality. ANS is thought to reflexively regulate the inflammatory response (« inflammatory reflex ») and autonomic dysfunction has been shown to be associated with deleterious sustained inflammatory stress. The Proof study is a prospective observational cohort of 1011 individuals, all aged 65 years at baseline (i.e. 2001), that was designed to assess the prognostic values of the ASN activity and its decline for the cardiovascular morbidity and mortality. We took advantage of the Proof cohort to explore the relationship between ScysC and ANS activity. Method The PROOF Cohort Study (PROgnostic indicator OF cardiovascular and cerebrovascular events) is constituted of elderly subjects aged 65 years in 2001 recruited from the electoral list of Saint-Etienne, France. Three initial 2-year examination were scheduled (2001–2007) along with late events monitoring which is still ongoing. At each examination, ANS activity was evaluated (baroreflex sensitivity by TILT testing) along with clinical and biological cardiovascular risk factors. Individuals with diagnosed CKD, history of myocardial infarction or stroke, heart failure, insulin-dependent diabetes mellitus, and a severe disease that limited life expectancy to 5 years or less could not be included in the Proof cohort. SCr and ScysC were measured from sera drawn at baseline and stored at -80°C, using IDMS-traceable enzymatic method and immunoturbidimetry calibrated method, respectively. Relationhip between SCysC and baroreflex sensitivity was analysed by univariate linear and multivariate logistic regressions. Results SCr and ScysC were measured in 803 patients of the Proof Cohort (71% of men) follow up to December 2019. Mean (+/- SD) SCr was 77 (+/- 15) micromol/l. ScysC was significantly associated to 18 years - all cause mortality (OR=4.1, p=0.01) and baseline CRP (p= 0.002). In univariate analysis, ScysC was the covariate most strongly associated to impaired BRS (coeff=-1.62, p=0.02), followed by diabetes (coeff=-0.73, p=0;04), gender (coeff=-0.59, p=0.001), hypertension (coeff=-0;48, p=0.009), active smoking (-0.47, p=0.01), CRP (-0.03, p=0;04) and SCr (-0.01, p= 0;02). Dyslipidemia and age were not significantly associated to BRS. In multivariate analysis, ScysC and gender (male) were the 2 covariates that independently and significantly associated with BRS. Conclusion By reporting for the first time an association between ScysC and BRS, our data suggest a new mechanism by which ScysC could predict excess risk of morbi-mortality beyond its sole ability to predict GFR. ScysC could be an easy-to-monitor marker of the “inflammatory reflex”.

The 7-Year Change in the Prevalence of Insulin Resistance, Inflammatory Biomarkers, and Their Determinants in an Urban South African Population.

Background Insulin resistance (IR) and subclinical inflammation are involved in pathological pathways leading to the development of biological cardiovascular risk factors and subsequent cardiovascular events. Therefore, monitoring these processes can provide advanced information on the trajectory of cardiovascular risk profile of a population and inform prevention and control strategies. We investigated changes in IR and subclinical inflammation in a population from Cape Town, South Africa, between 2008/09 and 2014/16. Methods In a total of 2503 (n = 797, 2008/09) and (n = 1706, 2014/16) participants, IR was calculated using five indices, i.e., insulin fasting, HOMA-IR, QUICKI, McAuley, and Matsuda while subclinical inflammation was measured using usCRP and gamma GT. Linear and logistic regression analyses and interaction tests were conducted. Results The mean age of participants was 53.2 (2008/09) and 48.2 (2014/16), respectively. In females, IR prevalence significantly decreased between 2008/09 and 2014/2016 by all indices (p ≤ 0.021), while subclinical inflammation prevalence increased from 54.7% (2008/09) to 57.1% (2014/16) based on usCRP and 29.6% to 33.4% based on gamma GT. In a multivariate analysis adjusted for the year of study, age, and gender, prominent factors associated with increased IR or subclinical inflammation were obesity levels measured using waist circumference, glycated haemoglobin, and fasting insulin levels. Conclusions Over the 7-year period, subclinical inflammation increased and this was associated with IR and the metabolic syndrome components, both of which are strong predictors of CVDs. The decrease in IR over the year period reflects in part the much younger age in the second survey.

Yoga and Cardiovascular Health Trial (YACHT): a UK-based randomized mechanistic study of a yoga intervention plus usual care versus usual care alone following an acute coronary event, BMJ Open 2019;9:e030119

Over the years Yoga has gained popularity throughout the world because of its various health benefits. Yoga is mind-body intervention which includes breathing, body postures and meditation (1). The studies on Yoga have documented to lower the stress and depression and are believed to improve biological cardiovascular risk factors (2–4). Cardiac rehabilitation (CR) is a program designed to strengthen cardiovascular health if you have experienced the heart related problems, and it has been shown to improve cardiovascular mortality and hospital re-admissions in patients with coronary heart disease (CHD). Yoga could, therefore, be a useful addition to CR. In this UK-based randomized report (Yoga and Cardiovascular Health Trial (YACHT), the hypothesis was that Yoga could be related to primarily with improvements in cardiovascular function in patients suitable for CR.

The impact of obesity on cardiovascular disease risk factor

Obesity has emerged as the most potential cardiovascular risk factor and has raised concern among public and their health related issues not only in developed but also in developing countries. The Worldwide obesity occurrence has almost has gone three times since 1975. Research suggests there are about 775 million obese people in the World including adult, children, and adolescents. Nearly 50% of the children who are obese and overweight in Asia in are below 5 years. There is a steep incline of childhood obesity when compared to 1971 which is not only in developed countries but also in developing countries. A considerable amount of weight gain occurs during the transition phase from adolescence to young adulthood. It is also suggested that those adultswho were obese in childhood also remained obese in their adulthood with a higher metabolic risk than those who became obese in their adulthood. In India, the urban Indian female in the age group of 30-45 years have emerged as an 〝at risk population” for cardiovascular diseases. To understand how obesity can influence cardiovascular function, it becomes immense important to understand the changes which can take place in adipose tissue due to obesity. There are two proposed concepts explaining the inflammatory status of macrophage. The predominant cause of insulin resistance is obesity. Epidemiological and research studies have indicated that the pathogenesis of obesity-related metabolic dysfunction involves the development of a systemic, low-grade inflammatory state. It is becoming clear that targeting the pro-inflammatory pathwaymay provide a novel therapeutic approach to prevent insulin resistance, particularly in obesity inducedinsulin resistance. Some cost effective interventions that are feasible by all and can be implemented even in low-resource settings includes - population-wide and individual, which are recommended to be used in combination to reduce the greatest cardiovascular disease burden. The sixth target in the Global NCD action plan is to reduce the prevalence of hypertension by 25%. Reducing the incidence of hypertension by implementing population-wide policies to educe behavioral risk factors. Reducing cigarette smoking, body weight, blood pressure, blood cholesterol, and blood glucose all have a beneficial impact on major biological cardiovascular risk factors. A variety of lifestyle modifications have been shown, in clinical trials, to lower bloodpressure, includes weight loss, physical activity, moderation of alcohol intake, increased fresh fruit and vegetables and reduced saturated fat in the diet, reduction of dietary sodium intake, andincreased potassium intake. Also, trials of reduction of saturated fat and its partial replacement by unsaturated fats have improved dyslipidaemia and lowered risk of cardiovascular events. This initiative driven by the Ministry of Health and Family Welfare, State Governments, Indian Council of Medical Research and the World Health Organization are remarkable. The Government of India has adopted a national action plan for the prevention and control of non-communicable diseases (NCDs) with specific targets to be achieved by 2025, including a 25% reduction inoverall mortality from cardiovascular diseases, a 25% relative reduction in the prevalence of raised blood pressure and a 30% reduction in salt/sodium intake. In a nutshell increased BMI values can predict the nature of obesity and its aftermaths in terms inflammation and other disease associated with obesity. It’s high time; we must realize it and keep an eye on health status in order to live long and healthy life.

Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population

BackgroundSocioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities.MethodsParticipants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men.ResultsHealth inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = − 0.1850; − 0.1683 and − 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = − 0.1661; − 0.1259 and − 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0–72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders.ConclusionTaken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.

The Effects of a Health Partner Program on Reducing Cardiovascular Risk Factors.

Previous lifestyle intervention research targeting prediabetes has primarily focused on weight loss, blood glucose, and lipid abnormalities. Far less is known whether lifestyle interventions lower other biological and physical risk factors for cardiovascular disease in overweight/obese adults with or without prediabetes. The aim of the study was to determine if a health partner program reduced biological and physical cardiovascular risk factors in overweight/obese adults with and without prediabetes at 1 year. A secondary data analysis was performed using the Center for Health Discovery and Well Being database at Emory University in the United States. A total of 246 (30 prediabetics and 216 non-prediabetics) were included in the analysis. At the 1-year follow-up, compared with non-prediabetics, prediabetics had significant improvements in body mass index, fasting blood glucose, and insulin resistance. Prediabetics also had higher increases in cardiorespiratory fitness. However, the methodological limitations and predominately high socioeconomic status level prevent definitive conclusions and generalizations.

Physical activity, sedentary behavior, and long-term cardiovascular risk in young people: A review and discussion of methodology in prospective studies

The long-term effects of physical activity (PA) or sedentary behavior on cardiovascular health in young people are not well understood. In this study, we use a narrative format to review the evidence for a prospective association with adiposity and other well-established biological cardiovascular risk factors in healthy young people, considering only studies with at least 2 years of follow-up. PA appears to elicit a long-term beneficial effect on adiposity and particularly markers of cardiovascular health. With adiposity, however, a few studies also reported that higher levels of PA were associated with higher levels of adiposity. Time spent sedentary does not appear to be related to adiposity or markers of cardiovascular health independent of PA. We then discuss the uncertainties in the underlying causal chain and consider a number of alternative modeling strategies, which could improve our understanding of the relationship in future studies. Finally, we consider the current methodology for assessing PA and sedentary time.

Psychosocial job factors and biological cardiovascular risk factors in Mexican workers.

Psychosocial job factors (PJF) have been implicated in the development of cardiovascular disease. The paucity of data from developing economies including Mexico hampers the development of worksite intervention efforts in those regions. This cross-sectional study of 2,330 Mexican workers assessed PJF (job strain [JS], social support [SS], and job insecurity [JI]) and biological cardiovascular disease risk factors [CVDRF] by questionnaire and on-site physical examinations. Alternative formulations of the JS scales were developed based on factor analysis and literature review. Associations between both traditional and alternative job factor scales with CVDRF were examined in multiple regression models, adjusting for physical workload, and socio-demographic factors. Alternative formulations of the job demand and control scales resulted in substantial changes in effect sizes or statistical significance when compared with the original scales. JS and JI showed hypothesized associations with most CVDRF, but they were inversely associated with diastolic blood pressure and some adiposity measures. SS was mainly protective against CVDRF. Among Mexican workers, alternative PJF scales predicted health outcomes better than traditional scales, and psychosocial stressors were associated with most CVDRF.

Serum Uric Acid and Cardiovascular Risk Among Portuguese Adolescents

PurposeThe aim of the study was to investigate the association between serum uric acid (SUA) and cardiovascular risk classes (CRCs) in adolescents using a cluster-based approach. MethodsA cross-sectional evaluation was carried out in the 2007–2008 school year, including adolescents born in 1990 and enrolled in the schools of Porto, Portugal. The analysis included 1,286 adolescents. To identify CRC, a normal mixture model was performed including several biological cardiovascular risk factors. A multinomial logistic regression model was applied to explore the association between SUA and each CRC. ResultsThree classes were extracted using model-based cluster analysis (low, medium, and high CRC). The high CRC accounted for the smallest proportion of participants (5.6%) and represented the adolescents with higher waist circumference, systolic and diastolic blood pressures, total cholesterol, triglycerides, and insulin levels. Adolescents at increased risk of cardiovascular disease had significantly higher mean concentrations of SUA compared with adolescents at low cardiovascular risk (55.0 vs. 51.5 mg/L in males and 41.9 vs. 37.6 mg/L in females). After adjustment and considering low CRC as reference, SUA was positively associated with high CRC in both sexes (odds ratio, 1.04; 95% confidence interval, 1.00–1.07 in males; and odds ratio, 1.04; 95% confidence interval, 1.01–1.07 in females). ConclusionsAmong 17-year-old adolescents, SUA increases were positively associated with higher CRC.

Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan.

BackgroundNeighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries.MethodsThis study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied.ResultsThe adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified.ConclusionsOur results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis

BackgroundThe aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups. MethodsMEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool. ResultsForty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD)=−5.85mmHg; 95% confidence interval (CI)=−8.81, −2.89) and diastolic blood pressure (MD=−4.12mmHg; 95%CI=−6.55, −1.69), heart rate (MD=−6.59bpm; 95%CI=−12.89, −0.28), respiratory rate (MD=−0.93breaths/min; 95%CI=−1.70, −0.15), waist circumference (MD=−1.95cm; 95%CI=−3.01, −0.89), waist/hip ratio (MD=−0.02; 95%CI=−0.03, −0.00), total cholesterol (MD=−13.09mg/dl; 95%CI=−19.60, −6.59), HDL (MD=2.94mg/dl; 95%CI=0.57, 5.31), VLDL (MD=−5.70mg/dl; 95%CI=−7.36, −4.03), triglycerides (MD=−20.97mg/dl; 95%CI=−28.61, −13.32), HbA1c (MD=−0.45%; 95%CI=−0.87, −0.02), and insulin resistance (MD=−0.19; 95%CI=−0.30, −0.08). Relative to exercise, yoga improved HDL (MD=3.70mg/dl; 95%CI=1.14, 6.26). ConclusionsThis meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease.

Non-Dipping Blood Pressure Profile in Narcolepsy with Cataplexy

BackgroundPatients with narcolepsy-cataplexy (NC) mostly exhibit undetectable hypocretin levels. Hypocretin system is one of the key players in the complex interaction between sleep and the cardiovascular system. We tested the hypothesis that hypocretin deficiency affects cardiovascular risk factors by measuring nighttime and daytime ambulatory blood pressure (BP) and the night-to-day BP ratio as well as endothelial dysfunction by the digital pulse amplitude response in drug-free patients with NC compared to controls.MethodologySleep, clinical and biological cardiovascular risk factors, fingertip peripheral arterial tonometry, and 24-hour ambulatory BP monitoring were recorded in 50 drug-free patients with NC and 42 healthy control subjects, except for BP monitoring available in all controls but in 36 patients with NC.Principal FindingsMore patients than controls were smokers, obese and with dyslipidemia. One-third of patients with NC were “non-dippers” (defined as <10% drop in BP during sleep) compared to only 3% of controls. The diastolic non-dipper BP profile had up to 12-fold higher odds of being associated with NC. We noted negative correlations between mean diastolic BP fall during night, REM sleep percentage and number of sleep onset REM periods, and a positive correlation with mean sleep latency on the MSLT. The digital pulse amplitude response measured by fingertip was similar between NC and controls.ConclusionWe found a high percentage of non-dippers in patients with NC with association with REM sleep dysregulation. The blunted sleep-related BP dip in NC may be of clinical relevance, as it may indicate increased risk for cardiovascular events.

Socio-economic distribution of cardiovascular risk factors and knowledge in rural India

To investigate the prevalence, screening and knowledge of cardiovascular risk factors (CVRFs) by socio-economic position (SEP) in rural India. An age- and sex-stratified random sample of 4535 adults was recruited from rural Andhra Pradesh and a questionnaire was administered to assess prevalence, screening and knowledge of CVRFs and record recent attempts to modify behaviour. Education, income and occupation were used to measure SEP. Lower fruit intake and higher tobacco and alcohol use were found in those with lower SEP. Overweight, physical inactivity, diabetes, hypertension, family history of cardiovascular disease (CVD) and previous CVD (men only) were greater in higher SEP participants. Lower SEP participants had less blood pressure, glucose or cholesterol screening and less knowledge of nine CVRFs. Regardless of SEP, participants knowledgeable of the harms of a CVRF were more likely to have attempted to modify behaviour. For example, knowledge of benefits of smoking cessation was associated with an increased odds ratio (OR) for attempting to quit: in educated participants-OR 3.67, 95% confidence interval (CI) 2.10-6.42; in participants with no education-OR 3.98, 95% CI 2.27-6.97. Some biological CVRFs were worse in higher SEP participants while some behavioural risk factors were worse in lower SEP participants. Lower SEP participants had less CVRF screening and knowledge of CVRFs. Those with knowledge of CVRFs were more likely to make healthy behavioural changes. Our findings suggest equipping rural Indians with knowledge about CVRFs may ameliorate projected future increases in CVD.

Associations of Psychological, Functional, and Biological Factors with Age Changes in the Self-Perceived Health of Old Persons

This research investigates the associations of psychological and biological factors with the self-perceived health of old persons. Participants were 411 residents of 11 retirement homes in Zagreb, Croatia: 104 men, 307 women, aged 56–96 years (average 79) at baseline, mobile, and not diagnosed with dementia. The variables measured, at baseline and at 2-year follow-up, were sociodemographics, self-perceived health, functional ability, cognitive function, depression, and social participation. Biochemical variables were measured from vein blood sample at baseline. Cross-sectional and longitudinal analyses explained 33%–38% of self-perceived health variance. Functional ability, depressive symptoms, and age were significant predictors of self-perceived health in all analyses. Two biological cardiovascular risk factors variables – glucose and urea – were significantly associated with self-perceived health.

Segment-specific carotid intima-media thickness and cardiovascular risk factors in Koreans: the Healthy Twin Study

Increased carotid intima-media thickness is associated with higher cardiovascular disease risk. This study aimed to evaluate the contributions of cardiovascular risk factors and inheritance to segment-specific carotid intima-media thickness. Cross-sectional observational study. A total of 706 Korean adults was selected from the Healthy Twin Study. The intima-media thickness of common, carotid bifurcation, and internal carotid artery were measured using B-mode ultrasound. Behavioral and biological cardiovascular risk factors were measured. Quantitative genetic and linear mixed analyses were performed to examine inherited and environmental contributions to intima-media thickness variation. Heritability of intima-media thickness was moderately high with estimates (95% confidence intervals) of 0.48 (0.37, 0.59), 0.38(0.27, 0.49), and 0.45(0.34, 0.55) for common, carotid bifurcation, and internal carotid artery, respectively. The additive genetic cross-trait correlations between the segments ranged between 0.43 and 0.75, suggesting a shared genetic influence on the three carotid segments. Additive inherited effects contributed 21% and 31% (common and internal carotid, respectively) to the total variance of the intima-media thickness, while measured cardiovascular risk factors accounted for 46% and 26% (common and internal carotid, respectively). The cardiovascular risk factors significantly associated with carotid intima-media thickness were as follows: in men, alcohol use (bifurcation); physical activity (common and internal); BMI (all segments); diabetes (bifurcation and internal); hypertension (internal); and HDL-cholesterol (common and bifurcation); and in women, smoking (bifurcation), hypertension (common), total and LDL cholesterol (bifurcation and internal), and hs-CRP (common and internal). Individual cardiovascular risk factors were differentially associated with carotid intima-media thickness by segments and sex. Inherited effects made a heterogeneous contribution to intima-media thickness by segment. These findings may explain the differences in cardiovascular disease occurrence between men and women.

P1-4 ALDH2 is a valid instrument for mendelian randomisation studies in alcohol epidemiology—the Guangzhou Biobank Cohort Study

IntroductionWestern observational studies show moderate alcohol use positively associated with many health outcomes. Moderate alcohol users differ systematically from others, making these observations susceptible to residual confounding. A randomised controlled...

Hormonal Contraceptive Use Among Adolescent Girls in Germany in Relation to Health Behavior and Biological Cardiovascular Risk Factors

To determine the association between hormonal contraceptive (HC) use, and behavior-related and biological cardiovascular risk factors among teenage girls in Germany. HC use was assessed among 2,285 girls aged 13-17 years who participated in the health survey for children and adolescents (German Health Interview and Examination Survey for Children and Adolescents, KiGGS), between years 2003 and 2006. Prevalence of HC use was determined according to sociodemographic variables, behavior-related health risks, and overweight status. We compared HC users and nonusers with respect to biological cardiovascular risk factors, including systolic and diastolic blood pressure, and serum concentrations of lipids, lipoproteins, high sensitivity C-reactive protein (hs-CRP), and homocysteine. HC users were more likely than nonusers to combine several behavior-related health risks, independent of sociodemographic factors. In particular, HC use was strongly associated with current smoking (odds ratio: 3.4, 95% confidence interval: 2.7-4.3). HC use and behavioral factors showed an additive effect on biological cardiovascular risk factors, explaining between 6% and 30% of the population variance. Relative contributions of HC use ranged from <1% for systolic and diastolic blood pressure to 12% for hs-CRP. HC use among 13-17-year-old girls in Germany is significantly correlated with a more unfavorable cardiovascular risk profile, which is partly explained by a clustering of behavioral risk factors among HC users. When prescribing HC to teenagers, physicians should systematically assess avoidable behavioral cardiovascular risk factors and provide counseling tailored to the risk profile of the individual patient.

Lifetime Vigorous But Not Light-To-Moderate Habitual Physical Activity Impacts Favorably on Carotid Stiffness in Young Adults

Higher levels of habitual physical activity favorably impact on arterial stiffness. It is not clear, however, whether lifetime habitual physical activities of different intensities carry the same protective effect and to what extent any such effect is mediated by other biological cardiovascular risk factors. We, therefore, examined longitudinal data on habitual physical activity and cardiovascular risk factors (8 repeated measures between the ages of 13 and 36 years) in 373 subjects in whom stiffness estimates of the carotid artery were assessed at age 36 years using noninvasive ultrasonography. The time spent in habitual physical activities (in minutes per week) throughout the longitudinal period was compared between subjects across tertiles of the following stiffness estimates: beta-stiffness index, distensibility and compliance coefficients, and the Young's elastic modulus. After adjustments for sex, body height, and other lifestyle variables, subjects in the highest tertile of the beta-stiffness index (ie, with stiffer arteries) had spent, on average, throughout the longitudinal period, less time in vigorous (-26.5 [95% CI: -45.9 to -7.1]) but less so in light-to-moderate habitual physical activities (-11.2 [95% CI: -53.5 to 31.1]) as compared with subjects in the lowest tertile. The difference in time spent in vigorous activities was greatly attenuated when further adjusted for blood lipids, cardiorespiratory fitness, fat distribution, resting heart rate, and mean arterial pressure (to -11.2 [95% CI: -29.4 to 7.0]). Similar results were found for the other stiffness estimates. Promoting vigorous intensity physical activities among the healthy young may, therefore, prevent arterial stiffness and related cardiovascular sequelae later in life, partly through its favorable impact on other biological cardiovascular risk factors.

Respiratory function and other biological risk factors for completed suicide: 40 years of follow-up of European cohorts of the Seven Countries Study

Background Prospective cohort studies on biological risk factors of completed suicide are scarce. We aimed to test which biological risk factors independently identify subjects at increased risk of suicidal death. Methods In the prospective cohort of the Seven Countries Study, 5,321 middle-aged men from Finland, Serbia, Italy, and Greece were included. Completed suicide (ICD-8 codes E950-959) was assessed during 40 years of follow-up. Biological cardiovascular risk factors (including forced vital capacity [FVC] and height) were tested for their role as predictors in multivariable Cox models stratified by country. Results There were 4518 deaths during follow-up, with 64 from suicide (1.4%). In univariable models, only FVC and height were strongly inversely related with suicide. Socio-economic status and being unmarried were potential confounders. In multivariable models taking these confounders into account, both a low FVC (0.30 for top vs. lowest quartile; 95% CI: 0.12–0.76; P = 0.006 for trend) and a low FVC/height ratio (0.37 for top vs. lowest quartile; 95% CI: 0.17–0.82; P = 0.004 for trend) were strongly inversely related with completed suicide. Limitations Information on proximal causes, such as prior suicidal ideation, emotional distress and depression, was lacking at baseline. Conclusions Poor respiratory function in middle-aged men was an independent risk factor for completed suicide.