Risk Of Cardiovascular Disease Events Research Articles

Targeting Hypertension: A Review on Pathophysiological Factors and Treatment Strategies.

Hypertension is one of the primary causes of cardiovascular diseases and death, with a higher prevalence in low- and middle-income countries. The pathophysiology of hypertension remains complex, with 2% to 5% of patients having underlying renal or adrenal disorders. The rest are referred to as essential hypertension, with derangements in various physiological mechanisms potentially contributing to the development of essential hypertension. Hypertension elevates the risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and mortality. First-line therapy for hypertension is lifestyle change, which includes weight loss, a balanced diet that includes low salt and high potassium intake, physical exercise, and limitation or elimination of alcohol use. Blood pressure-lowering effects of individual lifestyle components are partially additive, enhancing the efficacy of pharmaceutical treatment. The choice to begin antihypertensive medication should be based on the level of blood pressure and the existence of a high atherosclerotic CVD risk. First-line hypertension treatment includes a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker. Addressing hypertension will require continued efforts to improve access to diagnosis, treatment, and lifestyle interventions.

Abstract 09: The Diagnostic Accuracy of Using Borderline High Office Blood Pressure Thresholds to Diagnose Masked Hypertension According to the 2017 American College of Cardiology / American Heart Association Blood Pressure Guideline

Background: Compared to adults with sustained normotension (i.e. those with neither high office blood pressure [BP] nor high out-of-office BP), adults with masked hypertension (i.e. those with high out-of-office BP but not high office BP) have an increased risk of cardiovascular disease events. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends using ambulatory BP monitoring (ABPM) to detect masked hypertension among adults with an office BP close to the high BP threshold (i.e. office systolic BP [SBP] 120 to <130 mmHg or diastolic BP [DBP] 75 to <80 mmHg) and not taking antihypertensive medication (Class IIa recommendation). Limited data exist on the diagnostic accuracy of using this approach to detect masked hypertension. Methods: We analyzed data from the Improving the Detection of Hypertension Study, a community-based study of adult participants, from Upper Manhattan, not taking antihypertensive medication. Office BP was measured using a validated Omron oscillometric device (Model HEM-790IT or HEM-791IT) and ABPM was performed using a validated Spacelabs device (Model 90207). Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), and false negative rate (FNR) of having an office SBP 120 to <130 mmHg or DBP 75 to <80 mmHg for the diagnosis of high BP on ABPM were determined among 263 participants who had a mean SBP <130 mmHg and mean DBP <80 mmHg based on 6 SBP and 6 DBP readings from the first 2 visits (i.e. 3 SBP and 3 DBP readings per visit), and a sufficient number of ABPM readings (i.e. ≥10 awake and ≥5 asleep readings). High BP on ABPM was defined as mean awake SBP ≥130 mmHg or mean awake DBP ≥80 mmHg as per the 2017 ACC/AHA BP guideline. In a sensitivity analysis, high BP on ABPM was defined as mean 24-hour SBP ≥125 mmHg or mean 24-hour DBP ≥75 mmHg. Results: Mean (SD) age was 39.2 (12.8) years, 62.4% were female, 16.7% were non-Hispanic White, 14.4% were non-Hispanic Black, 6.8% were non-Hispanic Asian, 60.8% were Hispanic, and 1.3% were Other race/ethnicity. Of the 263 participants, 101 (38.4%) had an office SBP 120 to <130 mmHg or DBP 75 to <80 mmHg, and 69 (26.2%) had high BP on ABPM (awake SBP/DBP ≥130/80 mmHg). SN, SP, PPV, NPV, FPR, and FNR were 75.4%, 74.7%, 51.5%, 89.5%, 25.3%, and 24.6%, respectively. When using mean 24-hour SBP/DBP to define high BP on ABPM, SN, SP, PPV, NPV, FPR, and FNR were 72.7%, 75.8%, 55.4%, 87.0%, 24.2%, and 27.3%, respectively. Conclusions: The 2017 ACC/AHA BP guideline currently would require only 38.4% of participants with mean office BP <130/80 mmHg to be screened with ABPM for masked hypertension using a screening office BP threshold of SBP 120 to <130 mmHg or DBP 75 to <80 mmHg. However, this approach had a substantial rate of false positives and false negatives. Investigation of alternative diagnostic screening approaches for masked hypertension is needed.

Abstract P538: Relations of Left Ventricular Mass With Long-Term Cardiovascular and Health Outcomes: The Framingham Heart Study

Introduction: Although elevated left ventricular mass (LVM) is associated with increased risk for cardiovascular disease (CVD) events over short-term follow-up, limited data exists regarding echocardiographic assessments in relation to long-term health outcomes. Hypothesis: We assessed the associations of LVM to the risk of incident all-cause mortality, CVD, dementia, hypertension, diabetes, and chronic kidney disease (CKD) over 20 years of follow-up. Methods: We evaluated up to 3 serial echocardiographic observations (1991-2008) for up to 8218 Framingham Heart Study participants. We modeled LVM as indexed to height 2.7 , logarithmically transformed then standardized. Utilizing multivariable-adjusted time-dependent and interval-censored Cox proportional hazards models, we related log-LVMI to the incidence of CVD and other health outcomes through the end of 2019 by updating LVM and all covariates at multiple examinations. Results: Over a median follow-up of 17 years (max 29 years), our study participants (mean age 47 years, 54% women) experienced 1353 events for all-cause mortality, 948 for CVD, 293 for dementia, 1631 for hypertension, 492 for diabetes, and 627 for CKD. Higher log-LVMI was significantly associated with increased incident all-cause mortality and CVD, including its respective components: coronary heart disease, heart failure (with reduced and preserved ejection fraction), and stroke. Results were consistent for incident hard and atherosclerotic CVD. Higher LVMI was also significantly associated with increased incidence of dementia, hypertension, diabetes, and CKD (defined as eGFR<60 mL/min/1.73 m 2 and defined with urine albumin-to-creatinine ratio ≥30). Conclusions: In our large prospective community-based sample higher LVMI carries an adverse prognosis for multiple health outcomes over two decades of follow-up. These findings underscore the importance of maintaining an optimal LVM over the life course with control of its key determinants such as blood pressure and glycemia.

Abstract 62: Association of Cardiovascular Health Trajectories Through Young Adulthood With Later-Life Incident Cardiovascular Disease and Mortality: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Associations of mid-life cardiovascular health (CVH) and incident cardiovascular disease (CVD) are well-studied. Less is known about patterns of young adulthood (YA) CVH, including its changes, and associations with later-life CVD outcomes. Methods: CVH was defined by Life’s Essential 8 (LE8) score. First, we used latent class modeling (SAS Proc Traj) to determine trajectories of continuous CVH scores (0-100) for CARDIA participants with ≥3 CVH measurements in YA (from year [Y]0, mean age 25, to Y20, mean age 45). Second, we examined direction and magnitude of change in CVH status (low, moderate, or high) between 2 CVH measurements (at Y0 and Y20), comparing participants with increased, decreased, or stable CVH status. Outcomes included incident CVD (MI, heart failure, stroke, CVD death) after Y20. Cox proportional hazards regression was used to estimate HRs for associations of YA CVH patterns with incident CVD. Results: There were 4,257 participants in YA (44% female, 48% Black) included. In the trajectory analysis, we identified four distinct CVH trajectory groups ( Figure 1A ): compared to the Persistently-High CVH group, the Moderate-Low-Declining and Moderate-Declining CVH trajectory groups had substantially higher hazards for incident CVD ( Figure 1B ). In the CVH status change analysis (N=2,884; Figure 1B ), compared to Stable High CVH in YA, Stable Low CVH had a 19-fold higher risk for incident CVD, and both increasing and decreasing CVH status in YA had greater risk for incident CVD as well. Conclusions: Trajectories of declining moderate and low CVH in YA had substantially higher risk for later-life incident CVD events. Those with decreasing CVH and those who started with lower CVH and improved it through YA, were also at higher risk. These data suggest that early life CVH and maintaining high CVH through YA are both important for prevention of later-life CVD.

Abstract P370: Prevalence of the AHA Life's Essential 8 in Midlife Women and Its Prospective Associations With Total Mortality and Cardiovascular Diseases Events: The Study of Women’s Health Across the Nation (SWAN)

Objective: Midlife women face significant acceleration in CVD risk during the menopause transition. We aim to determine the cardiovascular health (CVH) as measured by Life's Essential 8 (LE8) in midlife women and to test the associations of midlife LE8 with future CVD events/total mortality. Methods: Participants were from the SWAN study, a multi-ethnic study of the menopause transition. LE8 includes diet, physical activity (PA), nicotine exposure, sleep, BMI, and blood lipids/glucose/pressure. The total and each LE8 scores (0 [lowest] - 100 [highest]) were calculated using AHA definitions. Scores were grouped into low (0-49), intermediate (50-74) and high (75-100) to characterize women. CVD events were self-reported between visits 1-16 and included: myocardial infarction, stroke, heart failure and revascularization. A subset of the events was adjudicated via medical record. Death certificates were obtained. Cox proportional hazards model was used to test the association between continuous LE8 metrics and CVD events/total mortality. Results: A total of 3302 women (mean age 46±3 years, 54% premenopausal) free of CVD at baseline were included. Among them, 28% achieved high total LE8 scores (mean 83±6) and many women had low scores on sleep, PA and diet ( Figure ). During a median (IQR) follow-up of 19 (7) years, 156 deaths and 202 CVD events were recorded. Higher midlife LE8 scores were associated with significantly lower risk of total mortality and CVD events adjusting for demographic and health factors ( Figure ). For individual components, BMI, blood lipids/glucose/pressure, nicotine exposure and sleep were associated with CVD events; BMI, blood glucose/pressure, nicotine exposure and PA were associated with total mortality ( Figure ). Conclusions: The prevalence of healthy diet, physical activity and healthy sleep is low in midlife women. Lower CVH is an independent risk factor of subsequent risk of CVD events/total mortality in midlife women. The findings highlight the need to promote healthy behaviors in midlife women.

Abstract P367: Regularity in Sleep and Eating Timing is Associated With Decreased Carotid Intima-Media Thickness in Healthy Young Adults

Introduction: Greater regularity in daily sleep and eating timing are independently and separately associated with lower carotid intima-media thickness (CIMT), a marker of subclinical atherosclerotic development in early adulthood. Not known is the extent to which achieving regularity in both sleep and eating would be associated with a lower CIMT as compared to achieving regularity in either behavior alone, or neither. Such information could help identify behavioral target priorities for cardioprotective interventions. Hypothesis: We tested the hypothesis that individuals achieving both sleep and eating regularity would have a lower CIMT than individuals with either sleep or eating regularity, or neither. Methods: Healthy adults aged 18-45 years (N=65, 29.7±7.2 years, 63% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Mean time for sleep midpoint (midpoint time between sleep onset and offset) and caloric midpoint (time at which 50% of total daily calories are consumed), sleep regularity (i.e., a mean sleep midpoint standard deviation (SD) of <60 minutes), and eating regularity (i.e., caloric midpoint SD < median of 154 minutes) values were generated. A 4-level ‘sleep and eating regularity’ variable was generated that distinguished between participants achieving regularity in: (1) both sleep and eating, (2) only eating, (3) only sleep, or (4) neither. A linear regression model evaluating the association between sleep and eating regularity with CIMT adjusting for age, sex, systolic blood pressure, sleep duration, and total energy intake was estimated. Results: Participants who achieved regularity in both sleep and eating (n=23) had the lowest M CIMT =0.523mm (SD=0.043), those who achieved only sleep regularity (n=10) had a M CIMT =0.549mm (SD=0.078), only eating regularity (n=16) had a M CIMT =0.568mm (SD=0.065), and those achieving neither sleep or eating regularity (n=16) had the highest M CIMT =0.575mm (SD=0.074). In a controlled model, the 4-level sleep and eating regularity variable was significantly associated with CIMT (F=2.95, p=.04, model R 2 =.33), with regularity in both demonstrating pairwise significance as compared to neither (p = 0.02) and eating regularity only (p = 0.02). Given that a 1-SD increase in CIMT (~0.06-0.07mm) has been shown to confer a 40% increased risk for first-time CVD events in adults <45 years old, the ~0.05mm difference in CIMT between regular vs. irregular groups has clinical meaning. Conclusions: Regularity in sleep and eating may be associated with lower subclinical atherosclerosis as early as young adulthood. Future studies evaluating the cardioprotective effects of promoting regularity of modifiable behaviors (eating and sleep) in adults at elevated CVD risk are warranted.

Abstract 08: Blood Pressure Percentile Charts Better Identify High Risk Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Current guidelines set a static threshold for diagnosis of hypertension based on absolute blood pressure (BP) levels for all ages. However, BP generally increases with age and relative levels tend to track within individuals from young adulthood on. We aimed to determine whether BP percentiles , compared to the current AHA/ACC clinical thresholds for hypertension, are better able to identify young adults at higher risk for future CVD events. Methods: Among 5,115 CARDIA participants (ppts; mean age 25 yrs; 54% female; 51% Black), we used baseline BP level and over 35 years of follow-up for fatal and non-fatal CVD events. We calculated normative BP percentiles for adults aged 18 and older using NHANES by estimating underlying BP among treated individuals combined with observed BP for untreated individuals (Figure). Using these BP Percentile Charts, we calculated the baseline BP percentile for each ppt. Adjusted survival analyses examined the association between BP percentile (in deciles) and incident CVD events over 30 years. C statistics for models using BP percentiles vs those using current guideline-recommended thresholds were compared to determine relative accuracy. Results: At baseline, mean S/DBP was 112/70 mmHg and <1% were on antihypertensive medications. Adjusted HRs for BP percentile decile demonstrated a dose-response effect with increasing risk associated with higher deciles of SBP. Compared to the 5 th decile young adults with SBPs in the highest decile 90-100% (SBP ≥127 for men and ≥120 for women) had a HR of 1.76 (95% CI 1.10-2.83). C statistics for models using BP percentiles were higher than for models using guideline-recommended thresholds (0.724 vs 0.713). No significant association was seen with DBP deciles. Conclusion: BP percentiles are better able to predict future CVD risk in young adults as compared to current age-invariant thresholds. These methods may help to risk stratify young adults and more accurately identify higher risk individuals for early prevention efforts.

Abstract P450: Assessing Admission Risk in Under-Resourced Neighborhoods: An Analysis by Race

Introduction: Cardiovascular disease (CVD) disproportionately affects socioeconomically disadvantaged communities and people of racial minority backgrounds. The Area Deprivation Index (ADI) is a validated measure of census-level characteristics based on income, education, employment, housing, and more. Although ADI is often linked to adversity, it is less well known if ADI is associated with racial disparities in CVD admission among cardiac patients living in disadvantaged communities. Hypothesis: We hypothesized that among a cohort of cardiac patients, risk for CVD admissions would be associated with ADI and that risk would vary by race. Methods: We identified ADI among n=27694 patients receiving care in a large health care system. We compared individual’s demographic variables using chi square for categorical variables and t-test for continuous variables. Using, ANOVA we determined differences in ADI by race. We further used ADI to identify neighborhoods with disproportionate rates CVD admissions using linear regression. Results: Figure Panel A shows that the ADI of American Indians, Blacks, and Asians was higher compared with that of Whites. Completion of an ANOVA test provided a p-value <0.05, showing that the average ADI is not equal between race groups. Panel B shows a linear association between higher ADI and increased risk of CVD event. Yet, some block groups were outliers with lower than predicted CVD events, labeled as low utilizers. Conclusion and Implications: Racial minority groups tended to have a higher ADI, yet some groups at high risk for CVD had disproportionately lower CVD events. These findings along with our team’s future work will inform interventions to address neighborhood level social determinants of cardiac health. Interventions that account for the unique social and healthcare contexts and inequities specific to at-risk communities will in turn help address the health challenges unique to these groups.

Abstract 18: Associations of Accelerometer and Questionnaire Measured Physical Activity With Incident Cardiovascular Events in Older Multiethnic Women

Purpose: Self-report misclassifies physical activity (PA) in older adults when compared to accelerometer measures of PA. Few studies have evaluated whether associations with CVD differ between accelerometer-measured and self-reported PA. Methods: We followed 5,719 women (mean age 79 years; 49.8% white, 33.3% black, 16.9% Hispanic) for incident adjudicated CVD (first myocardial infarction, stroke, or heart failure) in the Objective PA and Cardiovascular Health Study. Vector magnitude counts/15 sec epoch from a hip worn (2012-2014) ActiGraph GT3X+ accelerometer were used to define light PA (19-518 counts/15 sec) and moderate-to-vigorous (MVPA; ≥519). Self-reported light PA and MVPA were assessed with the CHAMPS questionnaire. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) controlling for age, race-ethnicity, education, smoking, number of comorbidities, self-rated health, SF36 physical function score, and accelerometer wear time. Harrell’s c-statistic estimated discrimination of CVD event risk for models with accelerometer versus questionnaire PA exposure measures. Results: Mean min/d in PA determined with the accelerometer and questionnaire were 288.4 and 54.3 for light PA, and 51.3 and 32.1 for MVPA. Age-adjusted Spearman correlations were r = 0.13 for light PA and r = 0.29 for MVPA. There were 862 incident CVD events through February 2023 (follow-up mean 7.5 years). HRs (95% CIs) per 30 min/d increment for accelerometer vs questionnaire were 0.95 (0.92, 0.98) vs 0.98 (0.92, 1.02) for light PA, and were 0.82 (0.76, 0.89) vs 0.99 (0.98, 1.00) for MVPA. C-statistics showed similar discrimination of CVD event risk for accelerometer (c = 0.70) vs questionnaire (c = 0.69) models when either light PA or MVPA was the exposure. Associations across tertiles (T1 = ref) for accelerometer PA were 0.92 (0.79, 0.99), 0.78 (0.65, 0.94) for light and 0.76 (0.64, 0.89), 0.58 (0.48, 0.71) for MVPA; and for questionnaire PA were 0.89 (0.75, 1.05), 0.91 (0.77, 1.08) for light and 0.75 (0.64, 1.08), 0.77 (0.65, 0.92) for MVPA. Associations for accelerometer- and questionnaire-measured PA were consistent when stratified by race-ethnicity (white, black, Hispanic) and age (<80 vs ≥80 years). Conclusion: In this study, accelerometers captured greater amounts of daily light PA and MVPA than did questionnaire assessment in older ambulatory women. Inverse associations for light PA and MVPA with incident CVD were stronger and achieved statistical significance when measured by accelerometer as compared to questionnaire assessment where associations were generally weaker and nonsignificant. The modest correlations between accelerometer and questionnaire PA suggest that accelerometers are capturing different aspects of cardiovascular health-promoting movement in older women that are not captured in a widely used questionnaire designed to assess PA in older adults.

Efficacy of 1-hour postload plasma glucose as a suitable measurement in predicting type 2 diabetes and diabetes-related complications: A post hoc analysis of the 30-year follow-up of the Da Qing IGT and Diabetes Study.

To evaluate whether 1-hour plasma glucose (1hPG) can be a comparable measurement to 2-hour plasma glucose (2hPG) in identifying individuals at high risk of developing diabetes. A total of 1026 non-diabetic subjects in the Da Qing IGT and Diabetes Study were included and classified according to baseline postload 1hPG. The participants were followed up and assessed at 6-, 20- and 30year follow-up for outcomes including diabetes, all-cause and cardiovascular mortality, cardiovascular disease (CVD) events, and microvascular disease. We then conducted a proportional hazards analysis in this post hoc study to determine the risks of developing type 2 diabetes and its complications in a '1hPG-normal' group (1hPG <8.6 mmol/L) and a '1hPG-high' group (≥8.6 mmol/L). The predictive values of 1hPG and 2hPG were evaluated using a time-dependent receiver-operating characteristic (ROC) curve. Compared with the 1hPG-normal group, the 1hPG-high group had increased risk of diabetes (hazard ratio [HR] 4.45, 95% CI 3.43-5.79), all-cause mortality (HR 1.46, 95% CI 1.07-2.01), CVD mortality (HR 1.84, 95% CI 1.16-2.95), CVD events (HR 1.39, 95% CI 1.03-1.86) and microvascular disease (HR 1.70, 95% CI: 1.03-2.79) after adjusting for confounders. 1hPG exhibited a higher area under the ROC curve (AUC) for predicting diabetes than 2hPG during the long-term follow-up (AUC [1hPG vs. 2hPG]: 10 years: 0.86 vs. 0.84, p = 0.08; 20 years: 0.88 vs. 0.87, p = 0.04; 30 years: 0.85 vs. 0.82, p = 0.009). Elevated 1hPG level (≥8.6 mmol/L) was associated with increased risk of developing type 2 diabetes and its long-term complications, and could be considered as a suitable measurement for identifying individuals at high risk of type 2 diabetes.

European Lipid Guidelines and Cardiovascular Risk Estimation: Current Status and Future Challenges.

Genetic, experimental, epidemiologic, and clinical data support the causal role of elevated levels of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis and cardiovascular disease (CVD). The recommendations of the 2019 European guidelines are based on the concept of differential CV risk, which in turn defines the LDL-C goals that should be achieved. The 2019 ESC/EAS guidelines for dyslipidaemia use the Systematic COronary Risk Evaluation (SCORE) model to assess CV risk, which provides a 10-year risk of fatal CV event. The SCORE model has recently been updated to reflect current rates of cardiovascular disease in Europe. The new SCORE2 model provides estimates of the 10-year risk of fatal and non-fatal CVD events in people aged 40-69 years, thus improving the identification of individuals at higher risk of a CVD event. However, as in the SCORE age is the main determinant of risk, young people have a relatively low estimated 10-year risk of a CV event even with high levels of one or more causal risk factors. Individuals with familial hypercholesterolaemia, who have elevated LDL-C levels from birth and have a high risk of premature CVD, are one example. The concept of cumulative LDL exposure is thus becoming increasingly important. This is also supported by Mendelian randomisation studies showing that carrying genetic variants associated with lower LDL-C levels reduces CV risk. These observations have introduced the concept of "cholesterol-years", which takes into account both LDL-C levels and time of exposure. It is crucial that future European guidelines pay more attention to this point.

Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study.

Women with breast cancer are at higher risk of cardiovascular disease (CVD) compared with women without breast cancer. Whether higher diet quality at breast cancer diagnosis lowers this risk remains unknown. We set out to determine if higher diet quality at breast cancer diagnosis was related to lower risk of CVD and CVD-related death. This analysis included 3415 participants from the Pathway Study, a prospective cohort of women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and followed through December 31, 2021. Scores from 5 diet quality indices consistent with healthy eating were obtained at the time of breast cancer diagnosis. Scores were categorized into ascending quartiles of concordance for each diet quality index, and multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. P values were 2-sided. The Dietary Approaches to Stop Hypertension diet quality index was associated with lower risk of heart failure (HR = 0.53, 95% CI = 0.33 to 0.87; Ptrend = .03), arrhythmia (HR = 0.77, 95% CI = 0.62 to 0.94; Ptrend = .008), cardiac arrest (HR = 0.77, 95% CI = 0.61 to 0.96; Ptrend = .02), valvular heart disease (HR = 0.79, 95% CI = 0.64 to 0.98; Ptrend = .046), venous thromboembolic disease (HR = 0.75, 95% CI = 0.60 to 0.93; Ptrend = .01), and CVD-related death (HR = 0.70, 95% CI = 0.50 to 0.99; Ptrend = .04), when comparing the highest with lowest quartiles. Inverse associations were also found between the healthy plant-based dietary index and heart failure (HR = 0.60, 95% CI = 0.39 to 0.94; Ptrend = .02), as well as the alternate Mediterranean dietary index and arrhythmia (HR = 0.74, 95% CI = 0.60 to 0.93; Ptrend = .02). Among newly diagnosed breast cancer patients, higher diet quality at diagnosis was associated with lower risk of CVD events and death.

Ten-year atherosclerotic cardiovascular disease risk trajectories among women veteran cancer patients

Despite a higher risk of cardiovascular disease (CVD) events in women cancer survivors than their male counterparts, importance of female sex has been underestimated due to under-representation of women in clinical research and male dominant CVD risk models. This study examined ten-year Atherosclerosis Cardiovascular Disease (ASCVD) risk trajectories in women veterans diagnosed with the ten most common cancers—bladder, breast, colorectal, endometrial/uterine/cervix, leukemia, liver, lung and bronchium, Non-Hodgkin’s lymphoma, melanoma, and thyroid cancer—using United States (US) Veterans Affairs (VA) Electronic Health Records data. The study included 78,556 women veterans aged between 30 and 80 years from diverse backgrounds treated at VA hospitals with ≥2 complete outpatient visit records in the VA health care system between January 01, 2007 and December 31, 2017. A steep rise in ASCVD risk score trajectories post-cancer diagnosis was observed among women diagnosed with bladder, breast, liver, lung and thyroid cancer, melanoma, and Non-Hodgkin’s lymphoma, compared to pre-cancer diagnosis periods, as well as significantly elevated pre-cancer ASCVD risk among all patients with cancer, other than thyroid cancer, compared to the no cancer group (p < 0.0001). ASCVD risk monitoring is highly recommended to reduce adverse cardiovascular events for women diagnosed with cancer, survivors, and for women at risk of future cancer incidences.

Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study.

To examine whether vasomotor symptoms (VMS) and migraine headaches, hypothesized to be vasoactive conditions, are associated with greater risk for cardiovascular disease (CVD) events including strokes. We performed a secondary data analysis of a subset of women (n = 1,954) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort, which began data collection at 18 to 30 y of age. We examined whether migraine headaches and VMS trajectories (characterized as minimal, increasing, and persistent) at CARDIA year 15 examination were associated with higher risk of CVD events and stroke (both ischemic and hemorrhagic) using Cox proportional hazards regression models and adjustment for traditional CVD risk factors (age, cigarette use, and levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides) and reproductive factors. Among women with minimal VMS (n = 835), increasing VMS (n = 521), and persistent VMS (n = 598), there were 81 incident CVD events including 42 strokes. Women with histories of migraine and persistent VMS had greater risk of CVD (hazard ratio [HR], 2.25; 95% CI, 1.15-4.38) after adjustment for age, race, estrogen use, oophorectomy, and hysterectomy compared with women without migraine histories and with minimal/increasing VMS. After adjustment for CVD risk factors, these associations were attenuated (HR, 1.51; 95% CI, 0.73-3.10). Similarly, women with histories of migraine and persistent VMS had greater risk of stroke (HR, 3.15; 95% CI, 1.35-7.34), but these associations were attenuated after adjustment for CVD risk factors (HR, 1.70; 95% CI, 0.66-4.38). Migraines and persistent VMS jointly associate with greater risk for CVD and stroke, although risk is attenuated with adjustment for traditional CVD risk factors.

Nonlinear association between proteinuria levels and the risk of cardiovascular disease events and all-cause mortality among chronic kidney disease patients

Background The association between proteinuria levels and cardiovascular disease (CVD) development and all-cause mortality in chronic kidney disease (CKD) patients remains controversial. Methods In this investigation, we conducted a retrospective analysis involving 1138 patients who were registered in the CKD-Research of Outcomes in Treatment and Epidemiology (ROUTE) study. The primary outcome of this study was the composite of cardiovascular events or all-cause death. Cox proportional hazards regression, smooth curve fitting, piecewise linear regression, and subgroup analyses were used. Results The mean age of the included individuals was 67.3 ± 13.6 years old. Adjusted hazard ratios (HRs) for UPCR in middle and high groups, compared to the low group, were 1.93 (95% CI: 1.28–2.91) and 4.12 (95% CI: 2.87–5.92), respectively, after multivariable adjustment. Further adjustments maintained significant associations; HRs for middle and high groups were 1.71 (95% CI: 1.12–2.61) and 3.07 (95% CI: 2.08–4.54). A nonlinear UPCR-primary outcome relationship was observed, with an inflection point at 3.93 g/gCr. Conclusion Among non-dialyzed patients with stage G2-G5 CKD, a nonlinear association between UPCR and the primary outcome was observed. A higher UPCR (when UPCR < 3.93 g/gCr) was an independent predictor of the primary outcome. Importantly, our study predates SGLT2 inhibitor use, showcasing outcomes achievable without these medications. Future research considerations will involve factors like SGLT-2 inhibitor utilization.

Age-dependent association of central blood pressure with cardiovascular outcomes: a cohort study involving 34 289 participants using the UK biobank.

It remained unclear whether central blood pressures (BP) was more closely associated with cardiovascular disease (CVD) than brachial BP in different age groups. To investigate the age-stratified association of CVD with brachial and central BPs, and to evaluate corresponding improvement in model performance. This cohort study included 34 289 adults without baseline CVD from the UK Biobank dataset. Participants were categorized into middle-aged and older aged groups using the cut-off of age 65 years. The primary endpoint was a composite cardiovascular outcome consisting of cardiovascular mortality combined with nonfatal coronary events, heart failure and stroke. Multivariable-adjusted hazard ratios expressed CVD risks associated with BP increments of 10 mmHg. Akaike Information Criteria (AIC) was used for model comparisons. In both groups, CVD events were associated with brachial or central SBP ( P ≤ 0.002). Model fit was better for central SBP in middle-aged adults (AIC 4427.2 vs. 4429.5), but model fit was better for brachial SBP in older adults (AIC 10 246.7 vs. 10 247.1). Central SBP remained significantly associated to CVD events [hazard ratio = 1.05; 95% confidence interval (CI) 1.0-1.1] and improved model fit (AIC = 4426.6) after adjustment of brachial SBP only in the middle-aged adults. These results were consistent for pulse pressure (PP). In middle-aged adults, higher central BPs were associated with greater risks of CVD events, even after adjusting for brachial BP indexes. For older adults, the superiority of central BP was not observed. Additional trials with adequate follow-up time will confirm the role of central BP in estimating CVD risk for middle-aged individuals.

Association between cardiovascular risk profile and impaired microvascular function in a Swedish middle-aged cohort (the SCAPIS study).

The aim was to investigate the relationship between microvascular function, cardiovascular risk profile, and subclinical atherosclerotic burden. The study enrolled 3809 individuals, 50-65 years old, participating in the population-based observational cross-sectional Swedish CArdioPulmonary bioImage Study. Microvascular function was assessed in forearm skin using an arterial occlusion and release protocol determining peak blood oxygen saturation (OxyP). Cardiovascular risk was calculated using the updated Systematic Coronary Risk Evaluation [SCORE2; 10-year risk of fatal and non-fatal cardiovascular disease (CVD) events]. The OxyP was compared with coronary artery calcification score (CACS) and to plaques in the carotid arteries. Individuals with OxyP values in the lowest quartile (Q1; impaired microvascular function) had a mean SCORE2 of 5.8% compared with 3.8% in those with the highest values of OxyP (Q4), a relative risk increase of 53%. The risk of having a SCORE2 > 10% was five times higher for those in Q1 (odds ratio: 4.96, 95% confidence interval: 2.76-8.93) vs. Q4 when adjusting for body mass index and high-sensitivity C-reactive protein. The OxyP was lower in individuals with CACS > 0 and in those with both carotid plaques and CACS > 0, compared with individuals without subclinical atherosclerotic burdens (87.5 ± 5.6% and 86.9 ± 6.0%, vs. 88.6 ± 5.8%, P < 0.01). In a population without CVD or diabetes mellitus, impaired microvascular function is associated with cardiovascular risk profiles such as higher SCORE2 risk and CACS. We suggest that OxyP may serve as a microcirculatory functional marker of subclinical atherosclerosis and CVD risk that is not detected by structural assessments.

Dietary protein sources, genetics, and cardiovascular disease incidence

BackgroundTo explore the potential correlation between the amount and source of dietary protein and cardiovascular disease (CVD), as well as the potential impact of genetic susceptibility on these connections. MethodsWe performed a prospective analysis of 98,224 participants from the UK. We measured dietary protein intake using two 24-hour dietary recall interviews. To analyze the data, we used multivariable-adjusted Cox regression models and restricted cubic spline models. Additionally, we calculated weighted genetic risk scores. ResultsA total of 8818 new cases of CVD were documented, which included 4076 cases of coronary artery disease (CAD) and 1126 cases of stroke. The study found a J-shaped association (p nonlinearity = 0.005) between CVD risk and the percentage of energy obtained from consuming plant protein. Higher intake of plant protein and whole protein was associated with a decreased risk of CVD. On the other hand, larger intakes of animal protein was linked to a higher occurrence of CAD. Additionally, increased intake of plant protein was also linked to a lower incidence of stroke. Replacing 5 % of animal protein-based energy intake with plant protein-based energy intake resulted in a 5 % decrease in CVD risk. LimitationsThere remains an effect of residual confounders. ConclusionThe consumption of larger amounts of plant protein, whole protein, and nut protein was found to be associated with a lower risk of CVD events. Conversely, higher intakes of animal protein was associated with an increased risk of CAD events. Furthermore, replacing 5 % of energy intake from animal protein with energy intake from plant protein was found to reduce the risk of CVD by 5 %.

ALLERGIC ASTHMA’S IMPACT ON THE CARDIOVASCULAR SYSTEM

Asthma, a chronic condition marked by airway inflam­mation, results from a complex interplay of genetic and environmental factors, including urban pollution. As­thma varies in severity and can be intermittent or per­sistent. Allergic asthma is most common and linked to elevated IgE levels and eosinophilic airway inflamma­tion. Additionally, asthma exacerbations, often triggered by respiratory infections, significantly impact patient’s well-being. Apart from its respiratory impact, asthma has notable implications for the cardiovascular system. Chronic inflammation, common to both asthma and car­diovascular disease (CVD), contributes to atherosclerosis, plaque rupture, and acute CVD events. Studies suggest that persistent asthma is associated with a higher risk of CVD events. While asthma poses challenges in diagno­sis and management, it also underscores the importance of monitoring cardiovascular health in asthma patients, given the clear link between these two conditions. Furt­her research is needed to better understand this complex relationship. Aim: The aim of this article is to highlight the signifi­cance of allergic asthma‘s negative impact on the car­diovascular system.

Immune checkpoint inhibitors in cancer: the increased risk of atherosclerotic cardiovascular disease events and progression of coronary artery calcium

BackgroundImmune checkpoint inhibitors (ICIs) have contributed to a significant advancement in the treatment of cancer, leading to improved clinical outcomes in many individuals with advanced disease. Both preclinical and clinical investigations have shown that ICIs are associated with atherosclerosis and other cardiovascular events; however, the exact mechanism underlying this relationship has not been clarified.MethodsPatients diagnosed with stages III or IV non-small cell lung cancer (NSCLC) at the Wuhan Union Hospital from March 1, 2020, to April 30, 2022, were included in this retrospective study. Coronary artery calcium (CAC) volume and score were assessed in a subset of patients during non-ECG-gated chest CT scans at baseline and 3, 6, and 12 months after treatment. Propensity score matching (PSM) was performed in a 1:1 ratio to balance the baseline characteristics between the two groups.ResultsOverall, 1458 patients (487 with ICI therapy and 971 without ICI therapy) were enrolled in this cardiovascular cohort study. After PSM, 446 patients were included in each group. During the entire period of follow-up (median follow-up 23.1 months), 24 atherosclerotic cardiovascular disease (ASCVD) events (4.9%) occurred in the ICI group, and 14 ASCVD events (1.4%) in the non-ICI group, before PSM; 24 ASCVD events (5.4%) occurred in the ICI group and 5 ASCVD events (1.1%) in the non-ICI group after PSM. The CAC imaging study group comprised 113 patients with ICI therapy and 133 patients without ICI therapy. After PSM, each group consisted of 75 patients. In the ICI group, the CAC volume/score increased from 93.4 mm3/96.9 (baseline) to 125.1 mm3/132.8 (at 12 months). In the non-ICI group, the CAC volume/score was increased from 70.1 mm3/68.8 (baseline) to 84.4 mm3/87.9 (at 12 months). After PSM, the CAC volume/score was increased from 85.1 mm3/76.4 (baseline) to 111.8 mm3/121.1 (12 months) in the ICI group and was increased from 74.9 mm3/76.8 (baseline) to 109.3 mm3/98.7 (12 months) in the non-ICI group. Both cardiovascular events and CAC progression were increased after the initiation of ICIs.ConclusionsTreatment with ICIs was associated with a higher rate of ASCVD events and a noticeable increase in CAC progression.