Cardiometabolic Multimorbidity Research Articles

Association of plasma homocysteine with cardiometabolic multimorbidity: a cross-sectional study in northwest China.

Elevated homocysteine (Hcy) levels have been linked to cardiovascular disease (CVD), but their association with cardiometabolic multimorbidity (CMM) remains uncertain. Data from the baseline survey of the China Northwest Cohort-Ningxia Project (CNC-NX) were used to recruit 22,566 participants. Demographic characteristics, lifestyle factors, and laboratory exam results were collected. Logistic regression was used to evaluate the association between Hcy levels and CMM risk. Restricted cubic splines (RCS) explored potential non-linear relationships, and subgroup analyses assessed the consistency of the association across distinct groups. Sensitivity analysis accounted for cluster variability. The final analysis included 18,126 participants. Higher Hcy levels were significantly associated with an increased risk of CMM (adjusted OR = 1.005, P = 0.003), with a linear relationship confirmed by RCS analysis (P for non-linearity = 0.142). There was a stronger association between Hcy-CMM in high-risk people, including elderly, males, and those with high BMI (P < 0.05). No significant association was observed between Hcy levels and more severe types of CMM. Elevated Hcy levels are correlated with an increased risk of CMM, warranting further investigation into the underlying mechanisms and potential interventions. Given the individual differences in the Hcy-CMM relationship, targeted comprehensive interventions for high-risk groups are necessary to reduce the risk of CMM.

Joint association of air pollutants on cardiometabolic multimorbidity

We estimated the association between combined exposure to air pollutants and the development of cardiometabolic multimorbidity (CM) and all-cause mortality. An air pollution score was calculated to determine the combined exposure to five air pollutants. CM was defined as the instance of at least two types of diseases. A genetic risk score (GRS) was calculated for each individual. A multistate regression model was used to investigate the effect of the combined associations of air pollutants on each stage of CM progression. After multivariable adjustment, the air pollution score was related with greater susceptibility of CM and all-cause mortality, and those with a high GRS for cardiovascular disease (CVD) or coronary heart disease (CHD) and a high air pollution score had a greater susceptibility of incident CM and all-cause mortality. The multistate model revealed that the greater air pollution score was connected with the susceptibility of progressing from disease-free baseline to having one cardiometabolic disease, and next to CM, and eventually to death. Combined exposure to five air pollutants were related with greater susceptibility of CM and all-cause mortality in a dose-dependent style and is related with the progression of CM and with all-cause mortality.

Relationship quality and educational attainment links to development of cardiometabolic morbidity and multimorbidity across middle adulthood.

The prevalence of cardiometabolic morbidity (e.g., high blood pressure, heart attack, stroke, type 2 diabetes) and multimorbidity development (2 or more cardiometabolic morbidities) are rapidly growing in the US. Cardiometabolic morbidity and multimorbidity are linked to poor well-being outcomes, high healthcare costs, and mortality. There is little known about cardiometabolic multimorbidity health disparities, particularly regarding mutable factors that might be targeted in future health interventions. In the present study, using a biopsychosocial framework (Biobehavioral Family Model), we examine whether cardiometabolic morbidity and multimorbidity development are linked to premorbid family and marital relationships and if it differs depending on socioeconomic status (i.e., educational attainment) using three waves of Midlife in the US (N = 4951). We assessed cardiometabolic development with three conceptualizations: number of cardiometabolic morbidities (i.e., count variable), individual cardiometabolic morbidities (i.e., diabetes, high blood pressure, stroke, heart attack), and severity of cardiometabolic multimorbidity (e.g., 3+ vs. zero morbidities). Family strain increased the number of cardiometabolic morbidities (OR = 1.17) and the severity of multimorbidity (e.g., 3+ morbidities: OR = 1.38). People with a high school education experienced family support as a buffer to the negative health impact of education level. Generally, marital quality appeared less impactful on cardiometabolic morbidity and multimorbidity development compared to family strain. Positive and negative family characteristics appear to function differently across educational attainment. These findings indicate that adults' non-intimate family relationships predict important outcomes such as diabetes, heart attack, stroke, and cardiometabolic multimorbidity and should be considered targets for preventative health interventions.

Gestational diabetes mellitus, body mass index, and cardiometabolic multimorbidity: a prospective cohort study

PurposeGestational diabetes mellitus (GDM) could increase the risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, evidence on its association with cardiometabolic multimorbidity (CMM) was limited. This study aimed to evaluate the association between GDM and the prevalence, incidence, patterns, and progression of CMM; and the role of body mass index (BMI) in such association. MethodsThis study included 203,372 women who have given birth in UK Biobank. The diagnoses of GDM and cardiometabolic diseases (including stroke, coronary heart disease [CHD], and T2DM) were reported by participants or obtained through linkage to inpatient hospital data until 31st December 2020. BMI was assessed at the baseline assessment. CMM was defined as having two or more of included cardiometabolic diseases. Logistic regression models and Cox proportional hazard models were used to assess the association between GDM and CMM, and the modifications on both additive and multiplicative scales were assessed to evaluate the effect of BMI on such association. ResultsA total of 1,217 women had a history of GDM, 2,351 participants had CMM at the end of follow-up and 1,601 was newly diagnosed during follow-up. GDM was associated with higher prevalence (odds ratio [OR]=4.64, 95% confidence interval [95% CI]=3.54-6.08) and incidence (hazard ratio [HR]=3.62, 95% CI=2.62-5.00) of CMM. In particular, GDM was associated with higher odds of T2DM, coexisting T2DM and vascular disease, and T2DM followed by vascular disease. Formal testing for effect modification suggested multiplicative modification by BMI for the association between GDM and incident CMM. ConclusionsGDM was associated with CMM in women’s late life, with multiplicative modification effects of BMI. Our results suggest that maternal and lifestyle interventions (e.g., weight management) are warranted for the primary and secondary prevention of CMM, particularly in women with a history of GDM.

Association between toothbrushing behavior and cardiometabolic multimorbidity among middle aged and older adults in North China: a cross-section study

ObjectivesTo evaluate the association between toothbrushing behavior and cardiometabolic multimorbidity (CMM) among middle-aged and older adults.MethodsData from the Beijing Health Service Survey were used to estimate the association between toothbrushing behavior and the risk of CMM using multilevel logistic models (N = 18,158).ResultsThere were 554 patients with CMM, with a prevalence of 3.05%. We found a higher risk of CMM for those with toothbrushing once or less (OR = 2.16, 95%CI: 1.80, 2.59) compared with those brushed two or more times per day in the crude model. After adjusting for confounding factors, the association between the two remained significant (OR = 1.68, 95%CI: 1.39, 2.04). The effect size was higher in adults with a higher education level (OR = 2.32) compared to those with a lower education level (OR = 1.39, P forinteraction<0.01).ConclusionsPoor toothbrushing practices were associated with CMM among middle-aged and older people. Longitudinal study can be considered to explore the causal association between the two and whether good toothbrushing habits can predict CMM and its progression.

Accelerated biological aging: unveiling the path to cardiometabolic multimorbidity, dementia, and mortality.

Cardiometabolic multimorbidity (CMM) and aging are increasing public health concerns. This prospective study used UK Biobank cohort to investigate the relationship between biological aging and the trajectory of CMM to dementia and mortality. CMM is the coexistence of at least two cardiometabolic diseases (CMD), including stroke, ischemic heart disease, and diabetes. Biological age was calculated using the KDM-BA and PhenoAge algorithms. Accelerated aging indicated biological age advances more rapidly than chronological age. The study included 415,147 individuals with an average age of 56.5 years. During the average 11-year follow-up period, CMD-free individuals with accelerated aging had a significantly greater risk of CMD (KDM-BA, HR 1.456; PhenoAge, HR 1.404), CMM (KDM-BA, HR 1.952; PhenoAge, HR 1.738), dementia (KDM-BA, HR 1.243; PhenoAge, HR 1.212), and mortality (KDM-BA, HR 1.821; PhenoAge, HR 2.047) in fully-adjusted Cox regression models (p < 0.05 for all). Accelerated aging had adjusted HRs of 1.489 (KDM-BA) and 1.488 (PhenoAge) for CMM, 1.434 (KDM-BA) and 1.514 (PhenoAge) for dementia, and 1.943 (KDM-BA) and 2.239 (PhenoAge) for mortality in participants with CMD at baseline (p < 0.05 for all). CMM significantly mediated accelerated aging's indirect effects on dementia by 13.7% (KDM-BA, HR) and 21.6% (PhenoAge); those on mortality were 4.7% (KDM-BA) and 5.2% (PhenoAge). The population attributable-risk of Life's Essential 8 score (≥80 vs. <80) were 0.79 and 0.43 for KDM-BA and PhenoAge accelerated aging, respectively. Biological aging involves the entire trajectory of CMM from a CMD-free state to CMD, to CMM, and ultimately to dementia and death. Life's Essential 8 may be a potential target to counter age acceleration.

The Cardiometabolic Multimorbidity Risk Profile of Females Living in Glendale, ILembe District of Kwa-Zulu Natal

Background: Empirical studies have indicated that cardiometabolic multimorbidity risk profiles are upsurging among the South African population. However, there is a limited number of studies that have been conducted to validate these findings in rural communities. Aim: To study the prevalence of cardiometabolic risk factors of females residing in rural Glendale in the ILembe District, South Africa. Methods: One hundred females (aged 18–40 years) voluntarily participated in a cross-sectional observational study. All participants completed an ISAK somatotype profiling, and measured their fasting cholesterol, glucose, blood pressure and resting heart rate. Results: Participants’ average age, body mass index, stature, and body mass, were 28.34 ± 7.07 years, 29.5 ± 8.06 kg/m2, 157.26 ± 6.09 cm, and 72.9 ± 21.12 kg, respectively. The cohort had a mean waist circumference of 94.2 ± 22.1 cm, hip circumference of 108.4 ± 20.9 cm, and waist-to-hip ratio of 0.86. Participants’ mean heart rate, systolic blood pressure, and diastolic blood pressure were 86.31 ± 8.68 bpm, 116.79 ± 16.34 mmHg, and 82.14 ± 10.87 mmHg, respectively. Eleven participants recorded a resting heart rate greater than 100 bpm. Average blood glucose, total cholesterol, low-density lipoprotein, and high-density lipoprotein recorded were 4.87 ± 1.26 mmol/L, 3.78 ± 0.94 mmol/L, 1.76 ± 1.86 mmol/L, and 1.31 ± 0.4 mmol/L. Eighty-three participants HDL-C were below the recommended normative value of 1.55 mmol/L. Conclusion: The average participant presented as overweight, with elevated diastolic blood pressure, and a resting heart rate that has been proven to increase one’s cardiometabolic multimorbidity risk profile. Additionally, a small portion of the cohort were identified to be prediabetic and diabetic. Large proportion of participants had low HDL-C levels suggestive of poor cardiovascular disease protection.

Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019

Abstract Background Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases. Purpose To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019. Methods A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as a systolic BP≥140mmHg and/or diastolic BP≥90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country. Results Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value &amp;lt;0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value&amp;lt;0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value &amp;lt;0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1). Conclusions The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM

Investigating the diverse role of ultra-processed foods on cardiometabolic multimorbidity: Highlights from the ATTICA prospective study (2002-2022)

Abstract Background/Introduction The role of ultra-processed foods (UPF) on multimorbidity is currently unknown with limited research implying the existence of complex associations among the diverse UPF categories. Purpose The aim of the present work was to investigate the association of total and subgroup intake of UPF with cardiometabolic multimorbidity, after twenty years of observation, in a Mediterranean region. Methods In 2001-2002, n=3,042 free-of-cardiovascular disease (CVD) men and women from Attica, Greece, were recruited. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. The NOVA Food Classification system was used to assign the food products as UPF using a standard methodology. The food products assigned as UPF were further grouped as "bread and cereals", "spreads and sauces", "sweets and desserts", "artificially and sugar-sweetened beverages", "processed meat products" and "savory snacks". Cardiometabolic multimorbidity was defined as the co-occurrence of two cardiometabolic diseases i.e., type 2 diabetes and CVD within a 20-year follow-up period in a sample of n=1,846 participants with available data. Results The median consumption level of UPFs was 26.6 (16.3) servings/week contributing to around 40% of participants total daily energy intake. Over the 20–year follow–up period, n=231 cases of cardiometabolic multimorbidity were recorded. Ranking from 1st tertile (lower intake– 11.8 mean servings/week) to 2nd tertile (23.3 mean servings/week) and 3rd tertile (44.7 mean servings/week) regarding the consumption level of UPF, 20-year cardiometabolic multimorbidity was 9.5%, 13.4% and 14.7% respectively. Multi-adjusted analysis revealed that one standard deviation (SD) increase in UPF intake (servings/week) or in contribution of UPFs to total energy intake (% total energy intake) was associated with 26% [Odds ratio (OR)=1.26, 95% Confidence Interval (95%CI) (1.17–1.85)] and 29% higher risk of cardiometabolic multimorbidity [OR=1.29, 95%CI (1.08–1.69)]. Among UPF subgroups, only in case of artificial and sugar-sweetened beverages [OR=1.06, 95%CI (1.02–1.13)] as well as spreads and sauces [OR=1.06, 95%CI (1.02–1.13)] a positive association was observed. In case of breads and cereals an inverse association was observed [OR=0.95, 95%CI (0.92–0.98)]. In the rest categories even if a positive trend was observed (all ORs&amp;gt;1) significance was not reached (all p-values&amp;lt;0.05). Conclusion A dose-response relationship between UPF consumption and elevated risk of cardiometabolic multimorbidity was emerged. However, the diverse categorization of UPFs accompanied by the contradicting associations revealed herein among the different subcategories of UPFs could imply the need to return to the evaluation of foods more on the basis of their nutritional role and less on the basis of their degree of processing. The nation context accompanied by specific dietary habits should also be taken into consideration.

Cardiometabolic multimorbidity and associated risk factors in a cohort identified through community-based screening in Eastern Nepal

Abstract Background Cardiometabolic multimorbidity constitutes a major cause of premature mortality and morbidity in low- and middle-income countries like Nepal. Early detection of associated risk factors and timely management at primary care centres can significantly reduce the impact at individual level. Lack of quality research data in resource poor setting often pose a challenge to plan for efficient delivery of health services. Purpose This analysis of secondary data from a cohort identified through a community based NCD intervention program intends to explore the distribution of cardiometabolic multimorbidity and associated risk factors in adult population of Eastern Nepal. Methods This report is a part of integrated NCD management strategy, a KHDC (Kidney, Hypertension, Diabetes, and Cardiovascular disease) program, implemented through community-based screening and interventions focused on primary level healthcare centres. The KHDC program involved screening of 14,517 individuals aged 18 years and above at baseline during a period of 2019-2023 for selected NCDs, including, cardiovascular diseases, hypertension, diabetes, and kidney disease. Individual level data was collected through anthropometric measurements, participants’ self-report, vitals assessment, laboratory parameters and diagnostic adjuncts including ECG and Echocardiography. Outcome of cardiometabolic multimorbidity1 was defined as presence of two or more of diabetes mellitus, and cardiovascular diseases including myocardial infarction and stroke. Results About 12.8% (n=1862) of the participants had at least one cardiometabolic multimorbidity, while less than one per cent (n=47) had two or more multimorbidity. Presence of at least one multimorbidity was associated with older age ≥ 40 years [OR: 3.870 (95% CI: 3.285-4.558)], male gender [OR: 1.326 (95% CI: 1.202-1.463)], BMI ≥ 23 kg/cm2 [OR: 1.348 (95% CI: 1.208-1.503)], current tobacco consumption [OR: 1.164 (95% CI: 1.038-1.305)] and co-occurrence of hypertension [OR: 1.736 (95% CI: 1.550-1.943)]. The presence of both diabetes mellitus and cardiovascular disease was associated with age ≥ 40 years [OR: 7.612 (95% CI: 1.846-31.395)] and co-occurrence of hypertension [OR: 2.544 (95% CI: 1.401-4.620)]. Conclusion Disproportionate burden of cardiometabolic multimorbidity was apparent among adult population screened in our program. Older age and co-occurrence of hypertension was identified as contributing factors for the presence of such multimorbidity. A baseline information on the distribution and risk factors for the same among general population can provide a valuable insight into understanding the disease progression and prognostic outcomes.Table of Outcomes

Association of impaired fasting glucose with cardiometabolic multimorbidity: TheKailuan study.

We investigated the association between impaired fasting glucose (IFG) and cardiometabolic multimorbidity (CMM) in the Chinese population. We included 119,368 participants, free of diabetes mellitus and cardiovascular disease, who participated in the health examination (2006, 2008, 2010) of the Kailuan Study. According to World Health Organization diagnostic criteria, participants were divided into normal fasting blood glucose (FBG) (<6.1 mmol/L) and IFG (FBG 6.1-6.9 mmol/L) groups. CMM was defined as having two or more cardiometabolic diseases, including myocardial infarction, stroke and diabetes mellitus. We used Cox proportional hazards models to evaluate associations between IFG and CMM. During a median follow-up period of 13.94 years, 2,432 CMM incident events occurred. After adjusting potential confounders, the hazard ratio (HR) and 95% confidence interval (CI) for CMM in the IFG group was 2.83 (95% CI 2.58-3.10) versus the normal FBG group. The HR of IFG for diabetes mellitus was 3.43 (95% CI 3.30-3.55), which was >1.25 (95% CI 1.13-1.37) for myocardial infarction, 1.16 (95% CI 1.07-1.25) for ischemic stroke and 1.06 (95% CI 0.88-1.27) for hemorrhagic stroke. Compared with normal FBG, HRs for risk of IFG for CMM were 2.73 (95% CI 2.48-3.02) in men and 3.86 (95% CI 2.92-5.09) in women. IFG was a risk factor for CMM. The effect of IFG on diabetes mellitus was stronger than that on other cardiometabolic diseases. The effects of IFG for CMM differed by sex.

Estimated glucose disposal rate, high sensitivity C-reactive protein and cardiometabolic multimorbidity in middle-aged and older Chinese adults: A nationwide prospective cohort study

AimTo explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM). MethodsA total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes. ResultsDuring a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33–2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12–1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77–3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (P < 0.001). ConclusionsLow eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.

Association of Short-term Pain and Chronic Pain Intensity With Cardiometabolic Multimorbidity Progression: A Multistate Markov Model Analysis.

The impact of pain intensity on the progression trajectories of cardiometabolic multimorbidity (CMM) is not well understood. We attempted to dissect the relationship of short-term pain (STP) and chronic pain intensity with the temporal progression of CMM. We conducted a prospective cohort study based on the UK Biobank participants. Incident cases of cardiometabolic diseases (CMDs) were identified based on self-reported information and multiple health-related records in the UK Biobank. CMM was defined as the occurrence of at least 2 CMDs, including heart failure (HF), ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D). The pain intensity was categorized into 5 levels based on pain duration and the number of sites involved, including chronic widespread pain (CWSP), chronic multilocation pain (CMLP), chronic single-location pain (CSLP), STP, and free-of-pain (FOP). Multistate models were used to assess the impact of pain intensity on the CMM trajectories from enrollment to initial cardiometabolic disease (ICMD), subsequently to CMM, and ultimately to death. A total of 429,145 participants were included. Over the course of a 12.8-year median follow-up, 13.1% (56,137/429,145) developed ICMD, 19.6% (10,979/56,137) further progressed to CMM, and a total of 5.3% (22,775/429,145) died. Compared with FOP, CMLP (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.06-1.17) and CWSP (HR, 1.26; 95% CI, 1.13-1.42) elevated the risk of transitioning from ICMD to CMM. STP (HR, 0.89; 95% CI, 0.82-0.96), CSLP (HR, 0.88; 95% CI, 0.82-0.95), and CMLP (HR, 0.87; 95% CI, 0.81-0.93) lowered the risk of transition from ICMD to mortality, and STP also reduced the risk of transition from enrollment to mortality (HR, 0.94; 95% CI, 0.89-0.98). The results of disease-specific transitions revealed that the influence of pain intensity varied across transitional stages. Specifically, CMLP and CWSP heightened the risk of conversion from T2D or IHD to CMM, whereas only CWSP substantially elevated the transition risk from HF to CMM. Our results highlighted reductions in chronic pain may mitigate both the onset and progression of CMM, potentially having an important impact on future revisions of cardiometabolic and pain-related guidelines.

Pregnancy loss and risk of cardiometabolic multimorbidity in Chinese women: the China Kadoorie Biobank study

BackgroundWhile the association between pregnancy loss and individual cardiometabolic diseases (CMDs) is well-established, its impact on the risk of coexisting CMDs remains unclear. Therefore, the aim of this study is to investigate the association between pregnancy loss with the risk of cardiometabolic multimorbidity in Chinese women.MethodWe analyzed the cross-sectional data of 299,582 female participants aged 30–79 years old from the China Kadoorie biobank. Cardiometabolic multimorbidity was defined as the coexistence of two or more CMDs, including coronary heart disease, stroke, hypertension, and diabetes. Multivariable logistic regression was used to evaluate the odds ratios (ORs) between the number and type of pregnancy loss with the risk of cardiometabolic multimorbidity, characterized by the number and type of CMD.ResultsAfter adjusting for confounding factors, pregnancy loss was found to be significantly associated with increased cardiometabolic multimorbidity risk (OR, 1.13 95% CI 1.08–1.19). Specifically, pregnancy loss due to spontaneous and induced abortion (OR 1.10, 95% CI 1.03–1.18 and OR 1.13, 95% CI 1.08–1.19, respectively). In contrast, no significant association was found between stillbirth and cardiometabolic multimorbidity (OR 1.03, 95% CI 0.95–1.11). The risk of cardiometabolic multimorbidity increases as the number of pregnancy loss increases (one pregnancy loss: OR 1.10, 95% CI 1.05–1.16, two or more pregnancy loss: OR 1.16, 95% CI 1.10–1.22). Similarly, the diagnosis of multiple CMDs increases with increasing number of pregnancy loss. Pregnancy loss was related to higher risk of cardiometabolic multimorbidity across most CMD combinations of CMDs.ConclusionPregnancy loss, in particular, spontaneous and induced abortion was significantly associated with greater risk of cardiometabolic multimorbidity. The associations were stronger among those with recurrent pregnancy loss.

Cardiometabolic multimorbidity and neuropsychiatric disturbances in multiregional older adults

AbstractIntroductionTo investigate the association between cardiometabolic multimorbidity (CMM) patterns and dementia‐related neuropsychiatric symptoms (NPSs) among multiregional and ethnic seniors.MethodsFour Asian studies (discovery) and UK Biobank (validation) were included. CMM was defined as two or more of hypertension, hyperlipidemia, diabetes mellitus, stroke, and heart disease. The latent class analysis identified CMM patterns. Two‐step individual participant data (IPD) and Cox regressions explored associations between CMM and the presence and short‐term (1–2 years) incidence of four neuropsychiatric subsyndromes: psychosis, hyperactivity, affective, and apathy.ResultsA total of 2950 Asian and 40,424 UK participants were included. Metabolic multimorbidity (≥2 of hypertension, hyperlipidemia, and diabetes mellitus) was associated with the presence (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.00–1.81; and 1.93, 1.73–2.16; in the respective data set), and incidence (hazard ratio [HR] = 3.91, 1.53–10.01; and 6.94, 2.52–19.07) of affective subsyndrome. Cardio‐cerebrovascular multimorbidity (≥2 of hypertension, stroke, and heart disease) was not associated with any NPSs.DiscussionMetabolic multimorbidity may exacerbate the neuropsychiatric disturbances of possible dementia.Highlights Four Asian multiregional and ethnic studies were included as the discovery data set, with the UK Biobank being applied as the validation data set. Metabolic multimorbidity had a higher presence and short‐term incidence of affective syndromes. Cardio‐cerebrovascular multimorbidity was not associated with any neuropsychiatric symptoms.

Prospective Association of the Mediterranean Diet with the Onset of Cardiometabolic Multimorbidity in a UK-Based Cohort: The EPIC-Norfolk Study

BackgroundCardiometabolic multimorbidity (CMM), defined as the co-occurrence of 2 or more cardiometabolic diseases, including myocardial infarction (MI), stroke, and type 2 diabetes (T2D), is an increasing public health challenge. Although poor diet is a known risk factor for a first cardiometabolic disease (FCMD), the relationship with subsequent occurrence of CMM is less studied. ObjectivesThis study aims to investigate the prospective association between baseline adherence to the Mediterranean diet and the onset of CMM across various follow-up durations. MethodsWe used data from the European Prospective Investigation into Cancer-Norfolk cohort study of 21,900 adults, aged 40–79 free of prevalent MI, stroke, and T2D at baseline (1993–1997). A median-based Mediterranean diet score and a pyramid-based MDS (pyr-MDS) were used to measure baseline adherence to the Mediterranean diet. Multistate modeling was employed to investigate associations with the FCMD and the subsequent CMM event. ResultsOver the entire follow-up period of 21.4 y (median), we observed 5028 FCMD and 734 CMM events. Multistate analysis indicated that the association between baseline Mediterranean diet and the risk of CMM may be stronger in shorter follow-up durations. Particularly, baseline pyr-MDS was significantly associated with the risk of subsequent CMM transitioning from FCMD when follow-up durations were limited to 10 and 15 y, with hazard ratio (95% confidence interval) being 0.67 (0.53, 0.84) and 0.80 (0.70, 0.92) per SD increase in pyr-MDS, respectively. Additionally, we observed that the risk of CMM transitioning from FCMD was modified by social class across shorter to longer follow-ups, where the impact of baseline Mediterranean diet was only significant in nonmanual workers. ConclusionsBaseline adherence to the Mediterranean diet was potentially associated with a lower risk of CMM transitioning from FCMD, particularly during shorter follow-up periods.

Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study.

Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.

Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity.

Cardiometabolic multimorbidity (CM) is an increasing public health concern. Previous observational studies have suggested inverse associations between coffee, tea, and caffeine intake and risks of individual cardiometabolic diseases; however, their associations with CM and related biological markers are unknown. This prospective study involved 172 315 (for caffeine analysis) and 188 091 (tea and coffee analysis) participants free of any cardiometabolic diseases at baseline from the UK Biobank; 168 metabolites were measured among 88 204 and 96 393 participants. CM was defined as the coexistence of at least 2 of the following conditions: type 2 diabetes, coronary heart disease, and stroke. Nonlinear inverse associations of coffee, tea, and caffeine intake with the risk of new-onset CM were observed. Compared with nonconsumers or consumers of less than 100 mg caffeine per day, consumers of moderate amount of coffee (3 drinks/d) or caffeine (200-300 mg/d) had the lowest risk for new-onset CM, with respective hazard ratios (95% CIs) of 0.519 (0.417-0.647) and 0.593 (0.499-0.704). Multistate models revealed that moderate coffee or caffeine intake was inversely associated with risks of almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. A total of 80 to 97 metabolites, such as lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls, were identified to be associated with both coffee, tea, or caffeine intake and incident CM. Habitual coffee or caffeine intake, especially at a moderate level, was associated with a lower risk of new-onset CM and could play important roles in almost all transition phases of CM development. Future studies are warranted to validate the implicated metabolic biomarkers underlying the relation between coffee, tea, and caffeine intake and CM.

A - 104 Cardiometabolic Multimorbidity Is Associated with Greater Amyloid Burden in Cognitively Stable Adults with Down Syndrome

Abstract Objective Nearly everyone (&amp;gt;90%) with Down Syndrome (DS) develops Alzheimer’s Disease (ad). Cardiometabolic conditions (CC) are known dementia risk-factors in the general population, and cardiometabolic multimorbidity (CM) increases MCI, dementia, and ad. CC are highly prevalent in DS and amyloid burden (AB) is associated with ad and elevated across lifespan in DS. However, there are no studies on the association between CM and AB in DS. Method We studied baseline data from 240 participants, 40–53 years (198 cognitively stable; 42 with MCI or dementia), from Alzheimer’s Biomarker Consortium-Down Syndrome (ABC-DS). Participants were grouped 0–1 or &amp;gt; 1 CC (hyperlipidemia, hypothyroidism, hypertension, cardiovascular conditions, stroke). Participants completed amyloid PET scan with [11C]-Pittsburgh compound B ([11C]-PiB) or [18F]-AV45 (florbetapir). Regional standard uptake value-ratios (SUVRs) were calculated relative to cerebellar cortex and transformed to Centiloid global AB scores for analysis. We tested association between CM and AB scores using hierarchical linear regression, including age and apolipoprotein E (ApoE) as covariates. Results The regression model revealed that CM was significantly associated with greater AB after accounting for age and ApoE [F (3,194) = 57.752, p &amp;lt; 0.001, ß = 0.228, 95% CI [0.007–0.449], p = 0.043]. Centiloid values were higher for two or more CC (Fig. 1). Conclusion Our results suggest that two or more CC is associated with greater AB in cognitively stable adults with DS. These findings help us understand the CM prodromal role in accelerating ad in DS and provide insights to preventative strategies. Future studies should explore how CM and related biomarkers, eg., chronic peripheral inflammation, influence ad in DS.

Cardiometabolic multimorbidity in Mexican adults: a cross-sectional analysis of a national survey.

Cardiometabolic multimorbidity is a rising phenomenon that has been barely explored in middle-income countries such as Mexico. This study aimed to estimate the prevalence, associated factors, and patterns of cardiometabolic multimorbidity (2 and 3+ diseases) in Mexican adults (≥20 years old) by age group. A cross-sectional and secondary analysis of Mexico's National Health and Nutrition Survey 2018-2019 was conducted. Information on eight diseases and other sociodemographic and health/lifestyle characteristics was obtained through self-reporting. Descriptive analyses were performed, and multinomial logistic regression models were calculated to identify the variables associated with cardiometabolic multimorbidity. Factor analysis and latent classes were estimated to determine disease patterns. The prevalence of cardiometabolic multimorbidity for the total population study was 27.6% (13.7% for people with 2 diseases and 13.9% for people with 3+ diseases). By age group, the prevalence of 2+ diseases was 12.5% in the age group of 20-39 years, 35.2% in the age group of 40-59 years, and 44.5% in the age group of 60 years and older. The variables of depressive symptomatology and having functional limitations (1+) were statistically associated with cardiometabolic multimorbidity in almost all age groups. Patterns of cardiometabolic multimorbidity varied among adults in different age groups. Understanding the behavior of cardiometabolic multimorbidity at various stages of adulthood is a resource that could be used to design and implement intervention strategies. Such strategies should correspond to the population's sociodemographic, health, and lifestyle characteristics and the specific disease patterns of each age group.