Cardiovascular Disease Events In Adults Research Articles

The built environment and cardiovascular disease: an umbrella review and meta-meta-analysis.

To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults. We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e., outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanisation, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect and excess significance bias. Meta-meta analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3,304 initial hits, 51 systematic reviews were included, covering five domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution and urbanisation in relation to CVD were scarce or lacking. Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs, and lack of evidence from LMIC's. PROSPERO CRD42021246580.

Dietary sodium to potassium ratio is an independent predictor of cardiovascular events: a longitudinal follow-up study

BackgroundThe current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults.MethodsThe participants of the Tehran Lipid and Glucose Study (men and women aged 30–84 years, n = 2050), free of CVD at baseline (2006–2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events.ResultsDuring a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus < 3049 mg/d) was significantly related to the increased risk of CVD (HR = 1.99, 95% CI = 1.06–3.74). Independent of the well-known risk factors, a 56% reduced risk of CVD was observed in the participants with a higher dietary K intake (HR = 0.44, 95% CI = 0.20–0.94). A Higher Na-to-K ratio was associated with an increased risk of CVD (HR = 1.99, 95% CI = 1.13–3.52).ConclusionOur study showed that the Na-to-K ratio might independently predict future risk of CVD events in adults.

Combined Dyslipidemia in Children and Adolescents: a Proposed New Management Approach.

Combined dyslipidemia (CD), the predominant abnormal lipid pattern in children and adolescents, is characterized by moderate/severe triglyceride elevation with reduced high-density lipoprotein cholesterol. CD is prevalent, present in 30-50% of obese adolescents. Epidemiologic and lipid sub-population findings demonstrate CD to be highly atherogenic. In the short term, CD responds well to lifestyle change; long-term results are lacking. Major longitudinal studies now confirm that CD in childhood predicts early cardiovascular disease events in adults. Targeted nutritional interventions can be safely and effectively introduced in young children. These findings support introduction of a new approach to CD management. New evidence supporting the atherosclerotic risk associated with CD and the effectiveness of lifelong diet interventions is reviewed and a new family-based primordial approach to CD beginning in infancy is proposed. Aligned with existing pediatric care recommendations, this has the potential to significantly decrease the development of CD.

Abstract 10334: Vital Exhaustion and Cardiac Biomarkers - The Atherosclerosis Risk in Communities Study

Introduction: Vital exhaustion (VE), defined as excessive fatigue and demoralization due to chronic stress, is a risk factor for cardiovascular disease (CVD), but the mechanism is unclear. We examined the association of VE with biomarkers of cardiac injury, neurohormonal stress and inflammation in the Atherosclerosis Risk in Communities (ARIC) study. Methods: Symptoms of VE were measured at ARIC visit 2 (1990-92, n= 11,588, mean age 57) using the Maastricht Vital Exhaustion Questionnaire (MVEQ). We analyzed the association of VE with cardiac biomarkers [High-sensitivity troponin T (Hs-TnT), N-terminal pro brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (Hs-CRP)] levels in adults without known CVD. Symptoms of VE (MVEQ scores) were categorized into quartiles. Elevated biomarker levels were defined as Hs-TnT ≥ 13 ng/L, NT-proBNP ≥ 125 pg/mL, and hs-CRP ≥ 2 mg/L. Logistic regression models adjusted for demographics and comorbidities were used to test for associations. The associations of VE (MVEQ score ≥16), elevated biomarkers, or both with incident CVD events after 6-year follow up was assessed by Cox proportional hazard regression. Results: Compared with the lowest quartile of VE (MVEQ ≤ 4), the highest quartile of VE (MVEQ 16-42), in adjusted models, was associated with elevated Hs-TnT, NT-proBNP, and hs-CRP [Odds Ratio (95% confidence interval) of 1.75 (1.34-2.29, p&lt;0.01), 1.40 (1.19-1.64, p&lt;0.01), and 1.14 (1.01-1.28, p&lt;0.01), respectively]. The highest quartile of VE was associated with increased risk of CVD events. The risk was increased further in the setting of both significant VE (MVEQ ≥16) and elevated biomarkers (Table). Conclusions: Symptoms of VE are associated with elevated Hs-TnT, NT-proBNP, and Hs-CRP independent of traditional CVD risk factors. The presence of VE and elevated cardiac biomarkers is associated with high risk of incident CVD events in adults without CVD.

Childhood cardiovascular risk factors and adult cardiovascular events

Brief summary: This prospective cohort study leveraged data from the International Childhood Cardiovascular Cohorts (i3C) Consortium, including 42 324 participants at baseline and followed-up over a mean of 35 years, in order to investigate associations between cardiovascular risk factors (CVRF, including body-mass index, systolic blood pressure, total cholesterol levels, triglycerides, and smoking) in childhood (mean age 11.8 years) with fatal and non-fatal cardiovascular events in adulthood (mean age 47 years). They showed that increases in each individual CVRF in childhood, and a combined-CVRF risk score, were associated with higher risks of fatal and non-fatal cardiovascular disease events in adults, robust to adjustment for adult CVRF levels.

Vitamin K status, all-cause mortality, and cardiovascular disease in adults with chronic kidney disease: the Chronic Renal Insufficiency Cohort

Vascular calcification contributes to cardiovascular disease (CVD) and mortality in individuals with chronic kidney disease (CKD). Vitamin K-dependent proteins function as calcification inhibitors in vascular tissue. We sought to determine the association of vitamin K status with mortality and CVD events in adults with CKD. Plasma dephospho-uncarboxylated matrix gla protein ((dp)ucMGP), which increases when vitamin K status is low, and plasma phylloquinone (vitamin K1), which decreases when vitamin K status is low, were measured in 3066 Chronic Renal Insufficiency Cohort participants (median age=61 y, 45% female, 41% non-Hispanic black, median estimated glomerular filtration rate [eGFR] = 41mL/min/1.73m2). The association of vitamin K status biomarkers with all-cause mortality and atherosclerotic-related CVD was determined using multivariable Cox proportional hazards regression. There were 1122 deaths and 599 atherosclerotic CVD events over the median 12.8 follow-up years. All-cause mortality risk was 21-29% lower among participants with plasma (dp)ucMGP <450pmol/L (n=2361) compared with those with plasma (dp)ucMGP ≥450pmol/L (adjusted HRs [95% CIs]: <300pmol/L=0.71 [0.61, 0.83], 300-449pmol/L=0.77 [0.66, 0.90]) and 16-19% lower among participants with plasma phylloquinone≥0.50nmol/L (n=2421) compared to those with plasma phylloquinone<0.50nmol/L (adjusted HRs: 0.50, 0.99nmol/L=0.84 [0.72, 0.99], ≥1.00nmol/L=0.81 [0.70, 0.95]). The risk of atherosclerotic CVD events did not significantly differ across plasma (dp)ucMGP or phylloquinone categories. Two biomarkers of vitamin K status were associated with a lower all-cause mortality risk but not atherosclerotic CVD events. Additional studies are needed to clarify the mechanism underlying this association and evaluate the impact of improving vitamin K status in people with CKD.

Atherosclerotic Cardiovascular Disease Events in Adults With CKD Taking a Moderate- or High-Intensity Statin: The Chronic Renal Insufficiency Cohort (CRIC) Study

Rationale & ObjectiveThe 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline uses risk stratification to guide the decision to initiate nonstatin lipid-lowering medication among adults with atherosclerotic cardiovascular disease (CVD). We determined atherosclerotic CVD (ASCVD) event rates among adults with chronic kidney disease (CKD) taking statin therapy within 2018 AHA/ACC cholesterol guideline risk categories.Study DesignObservational cohort study.Setting & ParticipantsAdults with CKD not on dialysis in the Chronic Renal Insufficiency Cohort (CRIC) study who were taking a moderate/high-intensity statin 1 year after enrollment (baseline for the current analysis, n = 1,753).Exposure2018 AHA/ACC cholesterol guideline risk categories: without a history of ASCVD, a history of 1 major ASCVD event and multiple high-risk conditions, and a history of ≥2 major ASCVD events.OutcomeAdjudicated ASCVD events after the year 1 study visit.Analytical ApproachWe calculated age-sex standardized rates for ASCVD events and age-sex adjusted hazard ratios for ASCVD events accounting for the competing risk of death.ResultsThere were 394 ASCVD events over a median follow-up period of 8 years. The ASCVD event rates (with 95% CI) per 1,000 person-years among participants without a history of ASCVD, with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 21.7 (18.4-25.1), 45.0 (37.8-52.3), and 73.3 (53.3-93.4), respectively. Compared with participants without a history of ASCVD, the HR (95% CI) rates for ASCVD events among those with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 1.89 (1.52-2.36) and 2.50 (1.85-3.39), respectively.LimitationsData on whether participants were taking a maximally tolerated statin dosage were unavailable.ConclusionsThe 2018 AHA/ACC cholesterol guideline identifies adults with CKD who have very high ASCVD risk despite taking a moderate/high-intensity statin.

The Novelty of Icosapent Ethyl in the Management of Hypertriglyceridemia and Alleviating Cardiovascular Risk.

Hypertriglyceridemia is believed to be independently associated with an elevated risk of cardiovascular disease (CVD) events. Lifestyle changes and dietary modifications are recommended for individuals with high serum triglyceride (TG) levels (150-499 mg/dl), and pharmacological therapy in addition to lifestyle modification is recommended when serum TG levels ≥ 500 mg/dl. A residual cardiovascular risk remains even in statin appropriate treated patients with CVD risk factors, and in this patient population, hypertriglyceridemia poses an independent and increased risk of ischemic events. In December 2019, the US FDA approved icosapent ethyl (IPE) as an adjunct to a maximally tolerated statin to reduce the risk of CVD events in adults with serum triglycerides > 150 mg/dl and have either established cardiovascular disease or diabetes and two or more additional CVD risk factors. Since IPE significantly decreases total ischemic events in the aforementioned patient population, it would be intriguing to know whether IPE alone added an advantage to lifestyle modification in the low-risk population, who has serum triglyceride between 150 mg/dl and 499 mg/dl.

Outcomes in adults with systolic blood pressure between 130 and 139 mmHg in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial and Systolic Blood Pressure Intervention Trial.

Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events. Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120 mmHg compared with standard SBP goal of less than 140 mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n = 1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n = 3484) that used identical SBP goal interventions. In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality. In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58-0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P = 0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40-0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76-1.89); events 1.91 vs. 1.60%/year]. Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.

Obesity in Children and Future Cardiometabolic Risk

Rates of pediatric obesity have increased substantially in recent years (1) and now pose a major risk for increased morbidity and premature mortality in adulthood for those affected, with cardiovascular disease (CVD) being a major contributor. In the current issue, Libman et al. (2) examine the relationship between glucose and insulin in overweight children and adolescents and a range of biomarkers for cardiovascular disease. They report that increased fasting and postprandial insulin are related to CVD risk factors, including systolic blood pressure and triglycerides, whereas glucose is not. These results are perhaps not surprising given what we already know about glucose homeostasis in obese children and adolescents (3) and recent evidence supporting a relatively weak relationship between elevations in fasting glucose within the normal range and incident CVD events in adults (4). Hyperinsulinemia is the hallmark of metabolic dysfunction in children and adolescents, with hyperglycemia not manifesting until a very late stage of β-cell failure (3), making the process far lengthier than in adults and reflecting the ability of the young pancreas to better compensate. Given the epidemic of childhood …

Constructing common cohorts from trials with overlapping eligibility criteria: implications for comparing effect sizes between trials

Comparing findings from separate trials is necessary to choose among treatment options, however differences among study cohorts may impede these comparisons. As a case study, to examine the overlap of study cohorts in two large randomized controlled clinical trials that assess interventions to reduce risk of major cardiovascular disease events in adults with type 2 diabetes in order to explore the feasibility of cross-trial comparisons The Action for Health in Diabetes (Look AHEAD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials enrolled 5145 and 10,251 adults with type 2 diabetes, respectively. Look AHEAD assesses the efficacy of an intensive lifestyle intervention designed to produce weight loss; ACCORD tests pharmacological therapies for control of glycemia, hyperlipidemia, and hypertension. Incidence of major cardiovascular disease events is the primary outcome for both trials. A sample was constructed to include participants from each trial who appeared to meet eligibility criteria and be appropriate candidates for the other trial's interventions. Demographic characteristics, health status, and outcomes of members and nonmembers of this constructed sample were compared. Nearly 80% of Look AHEAD participants were projected to be ineligible for ACCORD; ineligibility was primarily due to better glycemic control or no early history of cardiovascular disease. Approximately 30% of ACCORD participants were projected to be ineligible for Look AHEAD, often for reasons linked to poorer health. The characteristics of participants projected to be jointly eligible for both trials continued to reflect differences between trials according to factors likely linked to retention, adherence, and study outcomes. Accurate ascertainment of cross-trial eligibility was hampered by differences between protocols. Despite several similarities, the Look AHEAD and ACCORD cohorts represent distinct populations. Even within the subsets of participants who appear to be eligible and appropriate candidates for trials of both modes of intervention, differences remained. Direct comparisons of results from separate trials of lifestyle and pharmacologic interventions are compromised by marked differences in enrolled cohorts.

Demographics and correlates of five-year change in echocardiographic left ventricular mass in young black and white adult men and women: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

ObjectivesThe goal of this study was to determine the presence and correlates of change (Δ) in left ventricular (LV) mass by echocardiography in young adults. BackgroundLeft ventricular mass is known to be a powerful independent predictor for cardiovascular disease events in adults. However, little is known about Δ in LV mass over time in young adults. MethodsCoronary Artery Risk Development in Young Adults (CARDIA) is a multicenter, longitudinal, population-based study of black and white men and women who were ages 23 to 35 at the time of their initial two-dimensionally directed M-mode echocardiography exam (year 5); half the cohort had a repeat echocardiography exam five years later (year 10). Data were analyzed from 1,189 participants who had paired echocardiography studies. To minimize reader variability, blinded measurements on initial and repeat echocardiography were performed nearly contemporaneously by the same reader. ResultsIn multilinear regression analyses, significant (p < 0.05) predictors of year 10 two-dimensional guided M-mode LV mass included initial LV mass, initial body mass index (BMI) and change in BMI for all race/gender subgroups. Initial systolic blood pressure (SBP) was a significant predictor of year 10 LV mass in white men and black women; change in SBP was significant in black women with a trend towards significance in white women. Left ventricular mass remained constant in all race/gender subgroups, except black women, where it increased (by 5.9 g [mean]). Black women also had the largest increases in BMI and SBP. In black women, a five-year weight gain of 20 pounds and a 15-mm Hg increase in SBP would be expected to be associated with a 9% to 12% increase in LV mass. ConclusionsParticularly in black women, weight and blood pressure control may be important community health and treatment goals to prevent LV hypertrophy.