Cardiovascular Disease-free Individuals Research Articles

Remnant cholesterol and the risk of aortic valve calcium progression: insights from the MESA study

BackgroundRemnant cholesterol (RC) is implicated in the risk of cardiovascular disease. However, comprehensive population-based studies elucidating its association with aortic valve calcium (AVC) progression are limited, rendering its precise role in AVC ambiguous.MethodsFrom the Multi-Ethnic Study of Atherosclerosis database, we included 5597 individuals (61.8 ± 10.1 years and 47.5% men) without atherosclerotic cardiovascular disease at baseline for analysis. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), as estimated by the Martin/Hopkins equation. Using the adjusted Cox regression analyses, we examined the relationships between RC levels and AVC progression. Furthermore, we conducted discordance analyses to evaluate the relative AVC risk in RC versus LDL-C discordant/concordant groups.ResultsDuring a median follow-up of 2.4 ± 0.9 years, 568 (10.1%) participants exhibited AVC progression. After adjusting for traditional cardiovascular risk factors, the HRs (95% CIs) for AVC progression comparing the second, third, and fourth quartiles of RC levels with the first quartile were 1.195 (0.925–1.545), 1.322 (1.028–1.701) and 1.546 (1.188–2.012), respectively. Notably, the discordant high RC/low LDL-C group demonstrated a significantly elevated risk of AVC progression compared to the concordant low RC/LDL-C group based on their medians (HR, 1.528 [95% CI 1.201–1.943]). This pattern persisted when clinical LDL-C threshold was set at 100 and 130 mg/dL. The association was consistently observed across various sensitivity analyses.ConclusionsIn atherosclerotic cardiovascular disease-free individuals, elevated RC is identified as a residual risk for AVC progression, independent of traditional cardiovascular risk factors. The causal relationship of RC to AVC and the potential for targeted RC reduction in primary prevention require deeper exploration.

Sex Differences in Cardiovascular Risk Associated With Prediabetes and Undiagnosed Diabetes

Women with Type 2 diabetes (T2D) face up to 50% higher risk of cardiovascular disease than men. This study evaluated the extent to which prediabetes and undiagnosed T2D are associated with a greater excess risk of cardiovascular disease in women versus in men. Data were pooled from 18,745 cardiovascular disease-free individuals from the Atherosclerosis Risk in Communities Study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. The risk of coronary heart disease, ischemic stroke, and atherosclerotic cardiovascular disease (coronary heart disease or stroke) associated with prediabetes or undiagnosed T2D was estimated using Cox models adjusting for sociodemographic factors, concomitant risk factors, medication use, and menopausal status. Data were collected in 2022, and the analysis was performed in 2023. During a median follow-up of 18.6 years, the associations between prediabetes and risk of atherosclerotic cardiovascular disease were only significant in women (hazard ratio=1.18, 95% CI=1.01, 1.34, p=0.03) but not in men (hazard ratio=1.08, 95% CI=1.00, 1.28, p=0.06) (p-interaction=0.18). The associations between undiagnosed T2D and cardiovascular disease outcomes were significant in both sexes, but the effect was more pronounced in women (coronary heart disease: hazard ratio=1.83, 95% CI=1.4, 2.41, p<0.0001 in women vs hazard ratio=1.6, 95% CI=1.38, 2.07, p=0.007 in men; stroke: hazard ratio=1.99, 95% CI=1.39, 2.72, p<0.0001 vs hazard ratio=1.81, 95% CI=1.36, 2.6, p<0.0001; atherosclerotic cardiovascular disease: hazard ratio=1.86, 95% CI=1.5, 2.28, p<0.0001 vs hazard ratio=1.65, 95% CI=1.4, 1.98, p<0.0001) (all p-interactions≤0.2). Both White and Black patients exhibit similar sex differences. Prediabetes or undiagnosed T2D was associated with a greater excess risk of cardiovascular disease in women than in men. The sex differential in cardiovascular disease risk among those without the T2D diagnosis suggests the need for sex-specific guidelines in T2D screening and treatment.

Remnant Cholesterol and the Risk of Coronary Artery Calcium Progression: Insights From the CARDIA and MESA Study.

Remnant cholesterol (RC) contributes to residual risk of atherosclerotic cardiovascular disease, but population-based evidence on the prospective relationship between RC and coronary artery calcium (CAC) progression is rare. We pooled data obtained from 6544 atherosclerotic cardiovascular disease-free individuals from the CARDIA study (Coronary Artery Risk Development in Young Adults; n=2635) and MESA (Multi-Ethnic Study of Atherosclerosis; n=3909), with a mean±SD age of 47.2±19.8 years; 3019 (46.1%) were men who completed computed tomography of CAC at baseline. RC was measured as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus calculated LDL (low-density lipoprotein) cholesterol (LDL-C) estimated by using the Martin/Hopkins equation. Adjusted Cox models were used to assess the relationships between RC levels and CAC progression. We also performed discordance analyses examining the risk of CAC progression in RC versus LDL-C discordant/concordant groups using median cut points and clinically relevant LDL-C targets. During a median follow-up of 8.6 years, 2778 (42.5%) participants had CAC progression. After multivariable adjustment for demographics and cardiovascular risk factors, a 1-mg/dL increase in RC levels was associated with a 1.3% higher risk of CAC progression (hazard ratio, 1.013 [95% CI, 1.008-1.017]). Results were similar when we categorized individuals by RC quartiles. Furthermore, the discordant high RC/low LDL-C group had a significantly higher risk of CAC progression than the concordant low RC/LDL-C group regarding their medians (hazard ratio, 1.195 [95% CI, 1.063-1.343]) or when setting the clinical LDL-C cut points at 100 and 130 but not 70 mg/dL. The association remained robust across a series of sensitivity analyses. Elevated RC levels were associated with an increased risk of CAC progression independent of traditional cardiovascular risk factors, even in individuals with optimal LDL-C levels. URL: https://www. gov; Unique identifiers: NCT00005130 (CARDIA) and NCT00005487 (MESA).

Normal values of proximal aorta diameters in healthy Sub Saharan Africans: The TAHES study.

Reported ranges of normal values are mostly issued from studies performed with Caucasians. This study is a part of TAHES, a population-based prospective cohort study in Benin and aims to establish normal reference values for echocardiographic diameters of the proximal aorta in Africans. Transthoracic echocardiography (TTE) examinations were performed by four cardiologists following pre-defined protocols, and analyzed off-line by a single observer. Aortic root diameters were measured during diastole for sinuses of Vasalva (SV), sinotubular junction (STJ) and proximal ascending aorta (AA), and during systole for annulus. Upper limits were defined as the 95th percentiles. We included 513 normotensive, non-diabetic, and cardiovascular disease-free individuals (206 men, 307 women, age 40±14 years). The diameters of the proximal aorta were significantly greater in men. The inner-edge-to-inner-edge non-indexed upper values for the annulus, SV, STJ and AA were respectively 25, 34, 28.5, 32mm in men and 22, 30, 26, 30mm in women. The leading-edge-to-leading-edge upper values were respectively 38, 35, 36 for men and 34, 33, 32mm for women. No significant differences between sexes were recorded for body surface area (BSA)-indexed diameters of the annulus, STJ and AA. BSA-indexed SV dimension was greater in men than women were. SV, STJ, AA indexed-diameters correlated with age in both sexes but not for annulus indexed-diameter. Normal values from a general population in West Africa could to differ from those established in Caucasian populations. Ethnic-specific reference diameters are here proposed for appropriate diagnosis of proximal aortic diseases in sub-Saharan Africa.

Normal values of aortic root diameters in sub saharan africans: the TAHES study

Abstract Introduction Reference values of aortic root diameters (ARD) are proposed to define normal versus diseased aorta. However, reported ranges of normal values are mostly issued from Caucasian cohorts. Data on blacks African subjects are sparse and not issued from community-dwelling cohorts. Purpose Our study aimed to establish reference values for ARD in a Beninese general population cohort. Methods This study is a part of TAHES, a population-based prospective cohort study initiated in 2015 in the district of Tanvè, Republic of Benin. Demographic, blood pressure and blood glucose data were collected using a questionnaire adapted from WHO-STEPS tools. Transthoracic echocardiography examinations were performed by 4 cardiologists, and analyzed off-line by a single observer. ARD were measured using inner-edge to inner-edge diameters during diastole for sinuses of Vasalva (SV), sinotubular junction (STJ) and proximal ascending aorta (AA), and during systole for annulus. Normal limits were defined as the 95th percentiles. Variables are presented as mean ±SD (5th-95th percentiles). Results We included 513 normotensive, non-diabetic and cardiovascular disease-free individuals (206 men and 307 women, age 40±14 years [26–68]). The absolute values of ARD were significantly greater in men: the non-indexed ARD values for the annulus, SV, STJ and AA were respectively 21.3±2 (18.5–25), 28.5±3.4 (23–34), 24.1±3 (19–29) and 27±3 (22.5–32) mm for men and 19.3±1.8 (1.8 (15- 22), 25.8±2.8 (21.6–30), 22±2.7 (18–26) and 24.8±2.8 (21–30) mm for women, respectively (all p&amp;lt;0.0001). No significant differences between sexes were recorded for body surface area (BSA)-indexed ARD for Annulus, STJ and AA. BSA-indexed SV dimension was greater in men (17.3±2.6 mm; 13.5–22) than women (16.8±2.5 mm; 13–21). There was a correlation between SV, STJ, AA indexed-diameters and age in both sexes but not for annulus indexed-diameter (r=0.14, 0.19 and 0.36 for women and 0.34, 0.45 and 0.32 for men, all p&amp;lt;0.05). The upper limits for ARD are summarized in Table 1. In order to compare these values to those in Caucasians, the data of the NORRE study are also displayed. Conclusion Normal values from a general population in West Africa appear could to differ from those established in Caucasian populations. This ethnic-appropriate reference is proposed for appropriate diagnosis in patients in sub-Saharan Africa. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): APREL (CHU Limoges) Table 1

Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview.

To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents. English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots. Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60-0.82; p < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70-0.90; p < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of "the lower the better" hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals. Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.

High Plasma sRAGE (Soluble Receptor for Advanced Glycation End Products) Is Associated With Slower Carotid Intima-Media Thickness Progression and Lower Risk for First-Time Coronary Events and Mortality.

Objective- RAGE (receptor for advanced glycation end products) and EMMPRIN (extracellular matrix metalloproteinase inducer) are immune receptors for proinflammatory mediators. These receptors can also be found in a soluble form in the circulation. Soluble RAGE (sRAGE) has shown atheroprotective properties in animal studies, possibly by acting as a decoy receptor for its ligands. Whether sEMMPRIN (soluble EMMPRIN) has similar roles is unknown. We hypothesized that sRAGE and sEMMPRIN might be associated with vascular disease progression, incident coronary events, and mortality. Approach and Results- We measured baseline sRAGE and sEMMPRIN in 4612 cardiovascular disease-free individuals from the population-based Malmö Diet and Cancer cohort. Measurements of intima-media thickness in the common carotid artery were performed at inclusion and after a median of 16.5 years. sRAGE was negatively correlated with carotid intima-media thickness progression, independently of traditional cardiovascular risk factors, kidney function, and hsCRP (high sensitive C-reactive protein). Additionally, sRAGE was associated with decreased risk for major adverse coronary events (hazard ratio=0.90 [0.82-0.97]; P=0.009) and mortality (hazard ratio=0.93 [0.88-0.99]; P=0.011) during a follow-up period of 21 years. The relationship with mortality was independent of all considered potential confounders. We found no correlations between EMMPRIN, intima-media thickness progression, or prognosis. Conclusions- Individuals with high levels of circulating sRAGE have a slower rate of carotid artery disease progression and a better prognosis. Although its predictive value was too weak to promote sRAGE as a useful clinical biomarker in the population, the findings support further research into the potential anti-inflammatory and atheroprotective properties of this soluble receptor.

Anti-ApoA-I IgG antibodies are not associated with carotid artery disease progression and first-time cardiovascular events in middle-aged individuals.

IgG antibodies against apolipoprotein A-I (ApoA-I) have been found to be elevated in subjects from the general population with clinically manifest cardiovascular disease and in myocardial infarction patients with an adverse prognosis. Here, we investigated whether these antibodies are prospectively associated with carotid artery disease progression and with the risk for first-time cardiovascular events in individuals with no previous history of cardiovascular disease. We selected 383 subjects from the cardiovascular cohort of Malmö Diet and Cancer study who suffered a coronary event during a median follow-up period of 15.4 (10.3-16.4)years and 395 age- and sex-matched controls. None of the study participants had a previous history of coronary artery disease or stroke. Anti-ApoA-I IgG were measured by ELISA in serum samples collected at baseline. Intima-media thickness (IMT) was measured in the common carotid artery and in the carotid bifurcation at baseline and after 15.9 (±1.5)years. We found no associations between anti-ApoA-I IgG and carotid artery IMT at baseline or with IMT progression during follow-up. In Cox proportional hazards analyses adjusted for traditional cardiovascular risk factors, the hazard ratio (HR 95%CI) for the primary outcome, incident coronary events, was 0.97 (0.75-1.25), P=0.782, in subjects with anti-ApoA-I IgG within the highest tertile compared with the lowest tertile. Similarly, we did not find any associations with the secondary outcome, incident first-time stroke. Serum autoantibodies against ApoA-I do not correlate with disease progression and adverse events in cardiovascular disease-free individuals from the general population.

Sex Differences in Histomorphology of the Human Carotid Body

Knowledge of sex differences in the histomorphology of the carotid body is important in understanding observed differences in respiratory function and disorders. There are few studies on sex differences in the carotid body. This study therefore aimed at describing these differences in the histomorphology features of the human carotid body. Thirty six random carotid bodies from cardiovascular disease free individuals (20 male, 16 female) obtained during autopsy at the Department of Human Anatomy, University of Nairobi were studied. Specimens obtained within 48 hours of death were fixed in 10% formaldehyde solution and processed routinely for paraffin embedding. Seven micron thick serial sections were stained with H&E, Mason’s trichrome and examined with light microscope. Stereology was done to determine area occupied by parenchyma, stroma and vasculature. Data were analyzed using SPSS version 13.0. The student’s t test was used to compare sex differences. The data are represented using tables and macrographs.

Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention.

Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

Abstract 12511: Left Ventricular Hypertrophy by Electrocardiogram versus Cardiac Magnetic Resonance Imaging as a Predictor for Stroke: The MESA Study

Background: Left ventricular hypertrophy (LVH) is an established risk factor for stroke and is a component of the Framingham Stroke Risk Score (FSRS). It is unknown, however, if LVH detected by the electrocardiogram (ECG-LVH) is equally predictive of stroke as LVH detected by cardiac magnetic resonance imaging (MRI-LVH). Methods: We analyzed 4716 participants (mean age 61±10 years, 53.4% women, 38.2% whites) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of cardiovascular disease at baseline (2000-2002). ECG-LVH was defined as values &gt; 95 th percentile of left ventricular mass (LVM) derived from an established race- and sex-specific ECG model for estimating LVM indexed to weight. MRI-LVH was obtained from LVM by cardiac MRI using the 95th percentile cut-off value of observed LVM/predicted LVM calculated as 1.31. Multivariable Cox regression was used to examine the association between 1-standard deviation (SD) increase in estimated ECG-LVM and MRI-LVM as well as ECG-LVH and MRI-LVH, separately, with incident ischemic stroke. Harrell’s C-index was used to estimate the predictive ability of the FSRS model when either ECG-LVH or MRI-LVH was included. Results: Over a median follow-up of 11.2 years, 119 participants developed stroke. In a model adjusted for demographics and components of the FSRS, ECG-LVM and MRI-LVM as well as ECG-LVH and MRI-LVH were all predictive of stroke with ECG-LVM and MRI-LVH showing stronger associations with stroke in terms of hazard ratios but with wider confidence intervals (Table). However, the ability of FSRS model to predict stroke was slightly better when MRI-LVH (C-index 0.748, 95% CI: 0.514-0.829) was used as one of the FSRS components instead of ECG-LVH (C-index 0.739, 95% CI: 0.503-0.823), likelihood ratio test p 0.008. Conclusion: In asymptomatic cardiovascular disease-free individuals, both ECG-LVH and MRI-LVH are predictive of stroke. Using MRI-LVH slightly improves the predictive ability of the FSRS model.

Aortic artery distensibility shows inverse correlation with heart rate variability in elderly non-hypertensive, cardiovascular disease-free individuals: the Ikaria Study

The aim of this study was to evaluate the relation between aortic artery distensibility, expressed by pulse pressure (PP) and autonomic nervous system function expressed by heart rate variability (HRV), among elders. During 2009, 469 individuals (50 % males, mean age 75 ± 6 years old), permanent inhabitants of Ikaria Island, were enrolled. Among several sociodemographic, bioclinical, lifestyle, and dietary characteristics, and biochemical parameters related to cardiovascular risk, a digital, standard, 12-lead electrocardiogram (ECG) and 5-min ECG monitoring were recorded. Smart ECG measurement and interpretation programs were used for the automated measurement and interpretation of ECG intervals. Autonomic nervous system tone was estimated with the HRV-standard deviation of normal to normal intervals (SDNN)-in surface ECG. Pulse pressure was calculated as the difference between systolic and diastolic blood pressures. Pulse pressure showed a positive association with age, systolic blood pressure levels, and presence of diabetes mellitus (all P < 0.001) and an inverse correlation with logSDNN. Multiadjusted logistic regression analysis revealed that 10-unit increase in SDNN values decreases by 26 % the likelihood of having PP above 70 mmHg; when the analysis was stratified according to hypertension status, the relationship remained significant only among non-hypertensive individuals. These data support the hypothesis that cardiac sympathovagal disturbance correlates with impaired elasticity properties of aorta, indicating parallel impairment in cardiac autonomic modulation and mechanical vessel wall properties in elderly non-hypertensive individuals.

Selective serotonin reuptake inhibitor use is associated with right ventricular structure and function: the MESA-right ventricle study.

PurposeSerotonin and the serotonin transporter have been implicated in the development of pulmonary hypertension (PH). Selective serotonin reuptake inhibitors (SSRIs) may have a role in PH treatment, but the effects of SSRI use on right ventricular (RV) structure and function are unknown. We hypothesized that SSRI use would be associated with RV morphology in a large cohort without cardiovascular disease (N = 4114).MethodsSSRI use was determined by medication inventory during the Multi-Ethnic Study of Atherosclerosis baseline examination. RV measures were assessed via cardiac magnetic resonance imaging. The cross-sectional relationship between SSRI use and each RV measure was assessed using multivariable linear regression; analyses for RV mass and end-diastolic volume (RVEDV) were stratified by sex.ResultsAfter adjustment for multiple covariates including depression and left ventricular measures, SSRI use was associated with larger RV stroke volume (RVSV) (2.75 mL, 95% confidence interval [CI] 0.48–5.02 mL, p = 0.02). Among men only, SSRI use was associated with greater RV mass (1.08 g, 95% CI 0.19–1.97 g, p = 0.02) and larger RVEDV (7.71 mL, 95% 3.02–12.40 mL, p = 0.001). SSRI use may have been associated with larger RVEDV among women and larger RV end-systolic volume in both sexes.ConclusionsSSRI use was associated with higher RVSV in cardiovascular disease-free individuals and, among men, greater RV mass and larger RVEDV. The effects of SSRI use in patients with (or at risk for) RV dysfunction and the role of sex in modifying this relationship warrant further study.

Abstract 9760: Population-Level Cardiovascular Health Behavior and Health Factor Trends (1988-2008) and Projections to 2020 in US Men and Women: Results from the National Health and Nutrition Examination Surveys (NHANES)

Introduction: The AHA 2020 Impact Goals recently defined 4 health behaviors (smoking, body mass index [BMI], diet, and physical activity) and 3 health factors (cholesterol, blood pressure, and plasma glucose) that serve as population-level metrics for evaluating cardiovascular (CV) health. However, there have been no forward projections of population trends of these metrics to 2020. Methods: We used data from cardiovascular disease-free individuals from NHANES III (1988-1994) and recent 2-year cycles (1999-2000, 2001-2, 2003-4, 2005-6, 2007-8) to provide population-level, sex-specific trends in prevalence of poor, intermediate and ideal levels of CV health behavior/factors. We also performed age-adjusted forward projections to 2020 using weighted linear regression coefficients. Results: The Table describes prevalence of poor, intermediate and ideal CV health behavior/factor levels from 1988-2008, weighted linear regression coefficients β (SE), and 2020 projections for men. Favorable trends from 1988-2008 included declines in prevalence of current and former smoking, hypercholesterolemia, and hypertension. In contrast, there were adverse trends in BMI, and dysglycemia. Prevalence of physical activity levels and remarkably low diet quality scores showed minimal changes over time. Women had generally similar trends in CV health profiles. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes could increase to affect more than 45% and 75% of US men, respectively, and 42% and 55% of US women. Conclusions: Improvements in prevalence of smoking, hypercholesterolemia and hypertension since 1988 have been offset by increases in adiposity and dysglycemia in US men and women. If current trends in obesity and dysglycemia are not reversed rapidly (likely through improvements in diet and physical activity), achievement of the 2020 Strategic Impact Goals will be difficult.

Distribution of short and lifetime risks for cardiovascular disease in Italians

Guidelines for primary prevention recommend calculation of lifetime risk for cardiovascular disease (CVD) in addition to short-time risk. We aimed at evaluating the distribution of CVD lifetime risk and the percentage of Italians having low short-term, but high lifetime, risk. Cross-sectional general population-based cohort study. We included 8,403 (46% men) cardiovascular disease-free individuals aged 35-50 years, among those randomly recruited in the framework of the MOLI-SANI cohort. Participants were stratified into three groups: low short-time (10-year) (≤3% and non diabetic)/low lifetime, low short-time/high lifetime, and high short-time risk. Short-time risk was evaluated by the equation provided by the Italian CUORE project. Lifetime risk was evaluated using the algorithm derived from the Framingham cohort. High short-time risk was prevalent in 16% population (32% of men and 2% of women). Among individuals with low short-time risk, 80% had high lifetime risk (82% men and 78% women). The proportion of individuals with very low lifetime risk due to all optimal risk factors was 4.1% only (1.5% men and 6.3% women). A large proportion of Italian adults not qualified for CVD primary prevention because of their very low short-time predicted CVD risk, are in fact at high risk to develop a CVD event in their lifetime; therefore population-based approaches should be sought to modify the overall distribution of individual risk factors. These findings offer helpful information for policy makers involved in contrasting the burden of CVD, especially in women and young men.

Lack of association between the C825T polymorphism in G-protein beta-3 subunit and arterial blood pressure levels in cardiovascular disease free individuals: the ATTICA epidemiological study

Lack of association between the C825T polymorphism in G-protein beta-3 subunit and arterial blood pressure levels in cardiovascular disease free individuals: the ATTICA epidemiological study