Cardiovascular Disease In Individuals Research Articles

Obesity is Associated with Higher Blood Pressure and Higher Levels of Angiotensin II but Lower Angiotensin-(1-7) in Adolescents Born Preterm

To evaluate if obesity is associated with increased angiotensin II (Ang II) and decreased angiotensin-(1-7) or Ang-(1-7) in the circulation and urine among adolescents born prematurely. In a cross-sectional analysis of 175 14-year-olds born preterm with very low birth weight, we quantified plasma and urinary Ang II and Ang-(1-7) and compared their levels between subjects with overweight/obesity (body mass index ≥85th percentile, n = 61) and those with body mass index <85th percentile (n = 114) using generalized linear models, adjusted for race and antenatal corticosteroid exposure. Overweight/obesity was associated with higher systolic blood pressure and a greater proportion with high blood pressure. After adjustment for confounders, overweight/obesity was associated with an elevated ratio of plasma Ang II to Ang-(1-7) (β: 0.57, 95% CI 0.23-0.91) and higher Ang II (β: 0.21 pmol/L, 95% CI 0.03-0.39) but lower Ang-(1-7) (β: -0.37 pmol/L, 95% CI -0.7 to -0.04). Overweight/obesity was associated with a higher ratio of urinary Ang II to Ang-(1-7) (β: 0.21, 95% CI -0.02 to 0.44), an effect that approached statistical significance. Among preterm-born adolescents, overweight/obesity was associated with increased Ang II but reduced Ang-(1-7) in the circulation and the kidney as well as higher blood pressure. Obesity may compound the increased risk of hypertension and cardiovascular disease in individuals born prematurely by further augmenting the prematurity-associated imbalance in the renin-angiotensin system.

Dose-dependent effect of smoking on risk of coronary heart disease, heart failure and stroke in individuals with type 1 diabetes.

The aim of this study was to assess the potential dose-dependent effects of smoking on the risk of CHD, heart failure and stroke in individuals with type 1 diabetes. The study included 4506 individuals with type 1 diabetes who were participating in the Finnish Diabetic Nephropathy (FinnDiane) study. Intensity of smoking was estimated by packs per day and cumulative smoking by pack-years. Cox regression analyses were used to estimate the risk of incident CHD, heart failure or stroke during follow-up. One pack per day significantly increased the risk of incident CHD in current smokers compared with never smokers (HR 1.45 [95% CI 1.15, 1.84]), after adjustment for age, sex, HbA1c, hypertension, duration of diabetes and BMI. The risk of CHD in former smokers was similar to the risk in never smokers. The risk of incident heart failure was 1.43 (95% CI 1.03, 1.97) in current smokers per one pack per day and 1.37 (95% CI 1.05, 1.77) in former smokers, while the risk of incident stroke was 1.70 (95% CI 1.26, 2.29) and 1.49 (95% CI 1.14, 1.93), respectively. After further adjustments for lipids, however, the difference in the risk of heart failure in current and former smokers was no longer significant. Cumulative smoking data were similar to smoking intensity data. There is a dose-dependent association between smoking and cardiovascular disease in individuals with type 1 diabetes. In men in particular, the risk of incident stroke remains high even after smoking cessation and is increased in current and former smokers independently of other risk factors.

Dyslipidaemia and statin use in individuals aged 10 to

For individuals aged 10 to <40 years with type 1 diabetes and dyslipidaemia, US national guidelines recommend consideration of statin therapy based on age, low-density lipoprotein cholesterol (LDL-C) level and other cardiovascular risk factors. We evaluated dyslipidaemia prevalence, statin therapy use, and associations between not meeting target LDL-C [<100 mg/dL (<5.55 mmol/L)] and other cardiovascular disease (CVD) risk factors in individuals aged 10 to <40 years in the T1D Exchange clinic registry. In 7223 participants, statin use was 2% in 10 to <18 year olds, 4% in 18 to <25 year olds, and 21% in 25 to <40 year olds. Individuals not on statin therapy with LDL-C above target were more likely to have ≥1 additional CVD risk factor(s) than those with LDL-C in the target range for all age groups (all P < 0.01). While most individuals not on statin therapy had LDL-C in the target range, those who did not were more likely to have ≥1 additional CVD risk factor(s), and therefore longitudinal study of lipid levels and statin use is needed to see if treatment of dyslipidaemia to target LDL-C levels may lower the risk of future CVD in individuals aged 10 to <40 years with type 1 diabetes.

Is having asthma associated with an increased risk of dying from cardiovascular disease? A prospective cohort study of 446 346 Taiwanese adults

ObjectivesA significant proportion of cardiovascular disease (CVD) cannot be explained by well-known risk factors such as high cholesterol, hypertension and diabetes. One potential novel risk factor for CVD is asthma....

Tip 2 Diyabetli Bireylerde Abdominal Obezite/Adipozite ve Aterojenik Belirteçlerin Değerlendirilmesi

Amaç: Bu çalışmada tip 2 diabetes mellituslu (DM) bireylerde insülin direnciyle ilişkili olan abdominal obezite/adipozite göstergeleri ile aterojenik indeksin değerlendirilmesi amaçlanmıştır.&#x0D; Bireyler ve Yöntem: Bu kesitsel çalışmaya yaşları 18-65 yıl arasında değişen tip 2 DM’li yetişkin 100 gönüllü birey dahil edilmiştir. Bireylere ait genel ve sağlık bilgileri anket formu aracılığıyla alınmıştır. Bireylerin antropometrik ve vücut bileşim ölçümleri araştırmacılar tarafından kurallarına uygun şekilde yapılmıştır. Biyokimyasal bulgularından açlık glukoz, açlık insülin, glukozillenmiş hemoglobin (HbA1c), kan lipit parametreleri alınmıştır. Abdominal obezitenin değerlendirilmesinde bel kalça oranı ve bel boy oranı, abdominal adipozitenin değerlendirilmesinde viseral adipozite indeksi (VAİ) ile koniklik indeksi (Kİ) hesaplanmıştır. Ayrıca vücut adipozite indeksi (BAİ) hesaplanmıştır. Ateroskleroz risk değerlendirilmesinde serum aterojenik indeksi (Aİ) kullanılmıştır. Bireylerin insülin direnci değerlendirilmesinde homeostaz model değerlendirmesi (HOMA-IR) hesaplanmıştır.&#x0D; Bulgular: Çalışmaya dahil edilen erkek (%91.2) ve kadın (% 98.5) bireylerin tamamına yakınının şişman olduğu saptanmıştır. Bel boy oranına göre kadınların (%100) tamamının erkeklerin ise %94.1’inin hastalık riskinin yüksek olduğu belirlenmiştir. Aterojenik indeks sınıflamasına göre erkeklerin %85.3’ü, kadınların ise %83.3’ü yüksek riskli ateroskleroz grubundadır. Bireylerin insülin direnciyle Beden Kütle İndeksi (BKİ) (r=0.212, p=0.035), bel çevresi (r=0.222, p=0.027), VAİ (r=0.323, p=0.001), Aİ (r=0.318, p=0.001), viseral yağlanma % (r=0.201, p=0.044), HbA1c (r= 0.297, p=0.003) ve trigliserit düzeylerinin (r=0.289, p=0.004) pozitif ilişkili olduğu saptanmıştır. Bireylerin aterojenik indeks ile abdominal obezite/adipozite göstergeleri arasındaki ilişki değerlendirildiğinde ise erkeklerde Aİ, yaş (r=0.414, p=0.015) ve VAİ (r=0.778, p=0.000) ile kadınlarda ise bel kalça oranı (r=0.250, p=0.043), bel boy oranı (r=0.264, p=0.032), VAİ (r=0.708, p=0.000) ve açlık insülin değeriyle (r=0.271, p=0.006) pozitif ilişkili bulunmuştur.&#x0D; Sonuç: Artmış Aİ tip 2 DM riskinde artışla ilişkili olup kardiyovasküler hastalık gelişimini olumsuz etkilemektedir. Buna bağlı olarak Aİ tip 2 DM’li bireylerde kardiyovasküler hastalık risk tahmininde objektif bir gösterge olarak kullanılabilir. Ancak tip 2 DM bireylerde kardiyovasküler hastalıklar açısından en iyi risk tahminini bulmak için daha ileri çalışmalara gereksinme vardır.

E‐cigarette vapor elevates heart rate in mice with limited reactive aldehyde metabolism

BackgroundE‐cigarettes contain high levels of reactive aldehydes including acrolein, acetaldehyde and formaldehyde in addition to nicotine. However, the cardiovascular effects of e‐cigarette exposure are not well studied. Furthermore, ~560 million people of East Asian descent cannot efficiently metabolize these aldehydes in e‐cigarettes due to a genetic variant in aldehyde dehydrogenase 2, known as ALDH2*2. Therefore, we tested our hypothesis that e‐cigarette vapor exposure alters heart rates in wild type ALDH2 mice and these effects are exacerbated in ALDH2*2 knock‐in mice.MethodsTo test our hypothesis, both male and female wild type and homozygote ALDH2*2 mice (8–12 weeks old) were implanted with a mouse Biopotential Telemeter (Millar) and heart rate was acquired with LabChart 8 (AD Instruments) (n = 4/genotype). All mice were exposed to 60 puffs (5 sec duration and 60 ml puff volume) a day for 5 days. With each e‐cigarette exposure, we also monitored the reactive aldehyde levels in e‐cigarette vapor in real‐time by selective ion flow mass spectrometry. Furthermore, ALDH2 expression and activity in whole heart mitochondrial fractions were determined by biochemical assays (n= 3/genotype). Statistical analysis was performed using Graph Pad Prism 6.0. Data are expressed as mean ± SEM. Student's t‐test was used for comparison between two groups and ANOVA followed by Bonferroni correction was used for multiple variant comparisons (* indicating P value &lt;0.001).ResultsWhen compared to baseline heart rates for wild type and ALDH2*2 mice, e‐cigarette vapor exposure leads to a substantial drop in heart rate for both wild type (739 ± 6 vs. 502 ± 36* bpm, respectively) and ALDH2*2 mice (712 ± 5 vs. 500 ± 43* bpm, respectively). Additionally, 5 days of continuous e‐cigarette exposure increased the resting heart rate by 49 ± 9* bpm in wild type and 163 ± 9* bpm in ALDH2*2 mice respectively. Quantification of reactive aldehyde levels in e‐cigarettes revealed that e‐cigarette vapor contained high levels of acetaldehyde (1506 ± 179.1* ppb), acrolein (38.2 ± 4.7* ppb) and formaldehyde (52.7 ± 3.7* ppb) in contrast to ambient air (acetaldehyde 35.5 ± 4.6 ppb, acrolein 8.5 ± 1.3 ppb, and formaldehyde 7.1 ± 0.3 ppb). Furthermore, compared to wild type mice, both heart ALDH2 expression (1.3 ± 0.2 vs. 0.5 ± 0.04* ADU) and activity (3 ± 0.2 vs. 1.1 ± 0.07* μmol/min/mg) were markedly lower in ALDH2*2 mice.ConclusionTogether, these findings suggest that e‐cigarette vapor exposure triggers changes in heart rate that is more pronounced in ALDH2*2 mice. Moreover, e‐cigarettes contain reactive aldehydes, including high levels of acetaldehyde. Therefore, e‐cigarette smoking/exposure may increase the risk of developing cardiovascular disease in individuals with ALDH2*2 variant.Support or Funding InformationTobacco‐Related Disease Research Program, California, United States.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

S96. CARDIOVASCULAR DISEASE RISK IN PATIENTS WITH SCHIZOPHRENIA AND BIPOLAR DISORDER

BackgroundPatients with schizophrenia and bipolar disorder have markedly reduced life expectancy compared to the general population (15–20 years). A major contributor of excess death is cardiovascular disease (CVD) [1]. During the last decade, there have been several public health campaigns for health promotion and disease prevention, and tobacco legislation has become stricter. These strategies appear to have been effective in improving the health of the general Norwegian population [2]. It is unknown whether the elevated CVD risk in patients with schizophrenia and bipolar disorder has sustained in spite of these health promotion approaches. Here we investigate the development of CVD risk factors in a large representative sample of Norwegian patients with schizophrenia and bipolar disorder between 2002 and 2017. More specifically, we explored whether the CVD risk level was similar in a cohort from 2006 and a second cohort from 2017.MethodsCross sectional analysis was performed among DSM-IV diagnosed patients included from 2002–2005 (cohort 1) and from 2006–2017 (cohort 2), respectively. Cohort 1 consisted of 161 patients with schizophrenia and 109 patients with bipolar disorder, and cohort 2 consisted of 623 patients with schizophrenia and 387 patients with bipolar disorder. Comparisons were made between cohorts regarding demographic variables, psychiatric symptoms, tobacco use, body mass index, waist circumference, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, fasting glucose, systolic blood pressure, and diastolic blood pressure. ANCOVA was used for these analyses, with adjustments for age, duration of the disorder, and duration of psychopharmacological treatment.ResultsMean age was significantly higher for cohort 1 (35.1 years vs. 31.2 years, p < .001). There was no statistically significant difference in any of the other demographic variables or symptoms. Among patients with schizophrenia, there was no significant difference in the prevalence of CVD risk factors except from glucose being slightly increased in patients included in cohort 2 (p = .047). Among patients with bipolar disorder, there was a significant reduction in the level of total cholesterol, LDL, systolic, and diastolic blood pressure in cohort 2 (all p values < .01). These differences remained statistically significant after adjusting for age, duration of the disorder, and duration of psychopharmacological treatment.DiscussionDespite major advances in health promotion and disease prevention during the past decade, the level of CVD risk factors has remained high in patients with schizophrenia. While the level of some CVD risk factors improved in patients with bipolar disorder, they are still at increased risk of CVD. Thus, patients with severe mental disorders, especially schizophrenia, do not appear to have benefited from recent health promotion measures. Our findings also highlight the need for more effective interventions to reduce the risk of CVD in individuals with severe mental disorders, which may reduce the gap in life expectancy compared to the general population.

Epigenome‐Wide Association Study of Incident Cardiovascular Disease

DNA methylation is an ideal biomarker for many applications, because it has both the stability for prognostic use and the plasticity to be altered by environmental variables including diet. Investigations of relationships between DNA methylation and cardiovascular disease (CVD) have been performed, but these cross‐sectional analyses are susceptible to reverse causation, making causal inference difficult. Thus, we hypothesized that analysis of methylation in large‐scale cohorts with follow‐up for CVD development could provide potential risk biomarkers as well as mechanistic insights into disease risk. We performed an epigenome‐wide association study for incident CVD in individuals from the Framingham Heart Study Offspring Cohort and Women's Health Initiative studies. Methylation data were previously collected from whole blood samples using the Illumina Infinium HumanMethylation450k platform. Cox regression methods were used to identify relationships between relative methylation levels and incident CVD both at specific CpG sites and using a region‐based approach. We identified 10 single CpG sites and 4 regions demonstrating suggestive associations with incident CVD. Mendelian randomization approaches provided preliminary evidence of a causal relationship between methylation within the APOB gene and CVD. Investigations of cell‐type specific relationships using available epigenomic annotations highlighted the importance of monocytes in mediating the risk captured by methylation data in blood. Finally, relationships between these CpG sites and known traditional cardiovascular risk factors were examined to understand how they might interact to increase CVD risk. Based on these results, DNA methylation may provide a useful complement to existing cardiovascular risk prediction methods, and provides insights into genomic processes that may mediate the effects of genetics and environmental factors on disease risk.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Contemporary Drug Treatment of Hypertension: Focus on Recent Guidelines.

The 2017 American College of Cardiology/American Heart Association hypertension guidelines diagnose hypertension if systolic blood pressure (SBP) is ≥ 130mmHg or diastolic blood pressure (DBP) is ≥ 80mmHg. Increased BP is SBP 120-129mmHg with DBP < 80mmHg. Lifestyle measures should be used to treat individuals with increased BP. Lifestyle measures plus BP-lowering drugs should be used for secondary prevention of recurrent cardiovascular events in individuals with clinical cardiovascular disease (coronary heart disease, congestive heart failure, or stroke) and an average SBP ≥ 130mmHg or an average DBP ≥ 80mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) ≥ 10% and an average SBP ≥ 130mmHg or an average DBP ≥ 80mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of ASCVD < 10% and an average SBP ≥ 140mmHg or an average DBP ≥ 90mmHg. White coat hypertension must be excluded before starting antihypertensive drug treatment in individuals with hypertension with a low risk for ASCVD. BP should be lowered to < 130/80mmHg in patients with coronary heart disease, heart failure, or chronic kidney disease; after renal transplantation; for secondary stroke prevention; in lacunar stroke, peripheral arterial disease, and diabetes mellitus; and in ambulatory community-dwelling adults aged > 65years. The selection of antihypertensive drug treatment is discussed.

Incidence of cardiovascular disease in individuals affected by recent changes to US blood pressure treatment guidelines.

We evaluated the incidence of cardiovascular disease (CVD) in individuals whose blood pressure (BP) management strategy would change with adoption of recent US hypertension guidelines in two large, community-based cohorts with different racial and geographic compositions: the Framingham and Jackson Heart Studies (FHS and JHS). We assigned 11 237 FHS (mean age 46, 53% women) and 2948 JHS (mean age 55, 69% women) participants free of CVD and chronic kidney disease to one of five categories representing different treatment recommendations between 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Absolute incidence rates (incidence rate; per 1000 person-years) and multivariable-adjusted hazard ratios were calculated for each group; cohort-specific results were combined using fixed effect meta-analysis. CVD events occurred in 1047 FHS and 230 JHS participants during mean follow-up times of 11 and 8.9 years, respectively. Compared with individuals without hypertension, those with BP 140-149/<90 mmHg had increased risk for CVD regardless of treatment status [hazard ratio for untreated BP 140-149/<90 mmHg 1.96, 95% confidence interval (CI) 1.40-2.75; hazard ratio for treated BP 140-149/<90 mmHg 3.37, 95% CI 2.37-4.78]. The risk for those with treated BP 140-149/<90 mmHg was consistent in those aged at least 60 years (hazard ratio: 2.61, 95% CI 1.75-3.90). Statistical power was limited to evaluate the effect of diabetes. Individuals with treated BP 140-149/<90 mmHg have increased risk of CVD compared with those without hypertension including in participants at least 60 years. The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee recommendations to treat BP levels less aggressively may be associated with substantial residual CVD risk.

Interventions to Reduce Cardiovascular Risk in Children with Type 1 Diabetes.

Despite recent advances in improved glycemic control, the magnitude of lifetime risk from premature cardiovascular disease in individuals with type 1 diabetes remains at least 10 fold higher than in the general population. The availability of lipoprotein fractionation has allowed the spotlight for this increased risk to shift from dysglycemia to diabetes-induced dyslipidemia associated with insulin resistance. Interventions designed to simultaneously improve both factors can have distinct and additive effects on slowing the initiation and progression of atherosclerotic lesions. As fullblown cardiovascular disease is not evident during childhood, there is a critical need to identify the most predictable surrogate markers that could assign elevated risk, as well as the design of safe and targeted interventions that could improve outcomes in this population. This review will examine the evidence supporting the notion that cardiovascular disease in type 1 diabetes is associated with significant insulin resistance and it begins in childhood, making it necessary to design rational clinical trials that will significantly reduce risk in this population.

Sleep and cardiovascular effects of behavioural therapies for insomnia

Background: Insomnia increases the risk for cardiovascular diseases. Stimulus control therapy (SCT) and sleep restriction therapy (SRT) are behavioural interventions which are effective for managing insomnia, but their effectiveness in alleviating symptoms precursor to or indicative of cardiovascular diseases is unknown. Aims: To evaluate the effects of SCT and SRT, on insomnia and cardiovascular symptoms, in persons with chronic insomnia. Methods: A randomised controlled trial was used. Participants (n=55) randomised to either SCT, SRT or no treatment group completed the study. Outcome data were collected before and after a 4-week treatment period. Results: Participants in the SRT group reported a reduction in perceived insomnia, and those in the SRT and SCT groups showed a reduction in cardiovascular symptoms. Conclusion: SRT and SCT are effective for improving insomnia and have the potential to reduce risk of cardiovascular diseases in individuals with chronic insomnia, as well as to manage insomnia when it is experienced with cardiovascular diseases.

Correlation between the CHADS2, CHA2DS2-VASC scores and the incidence of cardiovascular disease in individuals without atrial fibrilation and their comparison with hellenic score and ASCVD risk

Aim: To assess the correlation between CHADS2 or CHA2DS2-VASC scores and the risk of incident cardiovascular disease (CVD) in individuals without atrial fibrillation (AF) attending a lipid clinic.

Effect of telehealth interventions on major cardiovascular outcomes: a meta-analysis of randomized controlled trials.

BackgroundTelehealth interventions (THI) were associated with lower levels of cardiovascular risk factors in adults, whereas the effect of THI on cardiovascular disease (CVD) still remains controversial. A meta-analysis was conducted to summarize the evidence from randomized controlled trials (RCT) which investigated potential impact of THI on the incidence of CVD in patients with or without prior CVD.MethodsPubMed, EmBase, and the Cochrane Library were searched to identify RCTs to fit our analysis through December 2016. Relative risk (RR) with its 95% confidence interval (CI) was used to measure the effect of THI using a random-effect model. Sensitivity analysis, subgroup analysis, heterogeneity tests, and tests for publication bias were also conducted.ResultsEight RCTs were included and with a total of 1635 individuals. The summarized results indicated that participants who received THI showed a significant reduction of the CVD incidence as compared with usual care (RR: 0.59; 95% CI: 0.47–0.74; P < 0.001). Furthermore, the effect of THI was greater in patients with history of CVD (RR: 0.55; 95% CI: 0.44–0.70; P < 0.001) than in patients without history of CVD (RR: 0.99; 95% CI: 0.51–1.94; P = 0.977). Sensitivity analysis suggested that the intervention effect persisted and the conclusion was not changed. Subgroup analysis indicated mean age, study quality might play an important role on the risk of CVD.ConclusionsThe findings of this study indicated THI could reduce the recurrence of CVD. Further large-scale trials are needed to verify the effect of THI on CVD in healthy individuals.

Enriching Diet with n-3 PUFAs to Help Prevent Cardiovascular Diseases in Healthy Adults: Results from Clinical Trials.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are believed to be important for cardiovascular health. Many investigations have been carried out in an attempt to examine the effect of n-3 PUFAs intake, in the form of supplementation or fortified foods, for the management of cardiovascular disease (CVD) and risk factors for CVD, whereas less is known about the effect on healthy individuals. The present study reviews the available literature in order to examine the relationship between n-3 PUFAs intake, either via supplementation or enriched food, and the prevention of CVD among healthy adults. Interventional clinical trials on subjects aged >18 years old with none of the established risk factors for CVD have been considered for review. n-3 PUFAs supplementation or enriched food may positively regulate triglycerides and some lipoprotein subsets, as well as several vascular and coagulation parameters, even in healthy patients, presenting no risk factors for CVD, suggesting a protective effect. Diet enrichment with omega-3 is likely to be useful in helping to lower the risk of developing CVD in healthy individuals, but still offers no strong evidence of a tangible benefit on a population level. Additional studies are needed to determine the optimal daily intake, especially to prevent the unfavorable effects of PUFAs over-consumption.

Gender differences in the association between physical activity and cognitive function in individuals with bipolar disorder

IntroductionBipolar disorder (BD) is accompanied by a high number of comorbidities and associated with an overall increased mortality. Especially obesity, systemic inflammatory processes and cognitive deficits are highly prevalent and increase with the course of illness. Physical activity (PA) is associated with beneficial effects on somatic comorbidities such as obesity or cardiovascular disease in individuals without psychiatric disorder. Furthermore, PA might increase neurocognitive performance and reduce systemic inflammation. ObjectiveThe aim of the study was to investigate the association between PA and neurocognitive function in euthymic individuals suffering from BD. Methods and participants120 individuals with BD, euthymic at test time, completed the self-reported International Physical Activity Questionnaire (IPAQ) assessing PA of the past seven days and were accordingly assigned to a specific activity category (low, moderate or vigorous). Furthermore, clinical parameters were gathered and cognitive tests analysing verbal-dependent intelligence, attention, executive functioning as well as memory were administered. ResultsFemale individuals in the vigorous PA group performed significantly higher in most of the cognitive domains compared to females with moderate or low PA. In males, we only found a significant difference in one test for attention between moderate/vigorous and the low activity group. ConclusionDifferences between PA groups in cognitive performance in female individuals with BD were obvious in almost all cognitive domains. As cognitive deficits are strongly associated with a worse course of disease and outcome, PA might offer a concomitant therapy targeting not only somatic comorbidities such as obesity and cardiovascular disease, but also neurocognition.

Cholesterol Efflux Capacity, High-Density Lipoprotein Particle Number, and Incident Cardiovascular Events: An Analysis From the JUPITER Trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin).

Recent failures of drugs that raised high-density lipoprotein (HDL) cholesterol levels to reduce cardiovascular events in clinical trials have led to increased interest in alternative indices of HDL quality, such as cholesterol efflux capacity, and HDL quantity, such as HDL particle number. However, no studies have directly compared these metrics in a contemporary population that includes potent statin therapy and low low-density lipoprotein cholesterol. HDL cholesterol levels, apolipoprotein A-I, cholesterol efflux capacity, and HDL particle number were assessed at baseline and 12 months in a nested case-control study of the JUPITER trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin), a randomized primary prevention trial that compared rosuvastatin treatment to placebo in individuals with normal low-density lipoprotein cholesterol but increased C-reactive protein levels. In total, 314 cases of incident cardiovascular disease (CVD) (myocardial infarction, unstable angina, arterial revascularization, stroke, or cardiovascular death) were compared to age- and gender-matched controls. Conditional logistic regression models adjusting for risk factors evaluated associations between HDL-related biomarkers and incident CVD. Cholesterol efflux capacity was moderately correlated with HDL cholesterol, apolipoprotein A-I, and HDL particle number (Spearman r= 0.39, 0.48, and 0.39 respectively; P<0.001). Baseline HDL particle number was inversely associated with incident CVD (adjusted odds ratio per SD increment [OR/SD], 0.69; 95% confidence interval [CI], 0.56-0.86; P<0.001), whereas no significant association was found for baseline cholesterol efflux capacity (OR/SD, 0.89; 95% CI, 0.72-1.10; P=0.28), HDL cholesterol (OR/SD, 0.82; 95% CI, 0.66-1.02; P=0.08), or apolipoprotein A-I (OR/SD, 0.83; 95% CI, 0.67-1.03; P=0.08). Twelve months of rosuvastatin (20 mg/day) did not change cholesterol efflux capacity (average percentage change -1.5%, 95% CI, -13.3 to +10.2; P=0.80), but increased HDL cholesterol (+7.7%), apolipoprotein A-I (+4.3%), and HDL particle number (+5.2%). On-statin cholesterol efflux capacity was inversely associated with incident CVD (OR/SD, 0.62; 95% CI, 0.42-0.92; P=0.02), although HDL particle number again emerged as the strongest predictor (OR/SD, 0.51; 95% CI, 0.33-0.77; P<0.001). In JUPITER, cholesterol efflux capacity was associated with incident CVD in individuals on potent statin therapy but not at baseline. For both baseline and on-statin analyses, HDL particle number was the strongest of 4 HDL-related biomarkers as an inverse predictor of incident events and biomarker of residual risk. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.

Seasonal variations in cardiovascular disease.

Cardiovascular disease (CVD) follows a seasonal pattern in many populations. Broadly defined winter peaks and clusters of all subtypes of CVD after 'cold snaps' are consistently described, with corollary peaks linked to heat waves. Individuals living in milder climates might be more vulnerable to seasonality. Although seasonal variation in CVD is largely driven by predictable changes in weather conditions, a complex interaction between ambient environmental conditions and the individual is evident. Behavioural and physiological responses to seasonal change modulate susceptibility to cardiovascular seasonality. The heterogeneity in environmental conditions and population dynamics across the globe means that a definitive study of this complex phenomenon is unlikely. However, given the size of the problem and a range of possible targets to reduce seasonal provocation of CVD in vulnerable individuals, scope exists for both greater recognition of the problem and application of multifaceted interventions to attenuate its effects. In this Review, we identify the physiological and environmental factors that contribute to seasonality in nearly all forms of CVD, highlight findings from large-scale population studies of this phenomenon across the globe, and describe the potential strategies that might attenuate peaks in cardiovascular events during cold and hot periods of the year.

Vitamin D status and its relationship with age in type 2 diabetic patients

Introduction: Type 2 diabetes has become a chronic worldwide epidemic with advancing complications and has caused many premature deaths. Its global prevalence is about 9.7%, with 92.4 million suffering from the disease. Vitamin D level has been recently considered as an adjustable risk factor of cardiovascular diseases in individuals with type 2 diabetes. Objectives: The aim of the current study is to investigate the frequency of vitamin D deficiency and the relationship between vitamin D serum levels and age in type 2 diabetes patients. Patients and Methods: In this descriptive-analytic study, 101 type 2 diabetes patients of Imam Ali clinic in Shahrekord were investigated. Serum vitamin D levels of the participants were measured by DRG (USA) Elisa kits. The results were analyzed using SPSS software with a 95% confidence level. Results: Of 101 studied patients, 32 were male and 69 were female. The average age of the subjects was 61.25 ± 11.75 years. The average age of the males was 63.09 ± 11.15 years and the average age of the females was 60.39 ± 12 years. Around 72 subjects were vitamin D deficient. No significant difference of vitamin D levels between males and females (P = 0.985) was detected. Serum vitamin D levels of type 2 diabetes patients were significantly positive correlated with their ages (r = 0.282, P = 0.004). Conclusion: In the present study the prevalence of vitamin D deficiency in type 2 diabetes patients was 71.3 %. We found a positive significant relationship between the vitamin D level and age. It is possible that ageing process is not one of the causes of vitamin D deficiency.

Atopic Dermatitis and Comorbidities: Added Value of Comprehensive Dermatoepidemiology

Atopic dermatitis is common and in its severe form is devastating. This chronic inflammatory dermatosis is part of the atopic syndrome, which includes asthma, food allergies, and hay fever and is known to be associated with mental health disorders. In line with psoriasis, several recent observational studies using national survey and linkage data have suggested a link between atopic dermatitis and cardiovascular disease. The atopic dermatitis field can benefit from the past experiences in psoriasis research and should not follow the same path, but, rather, aim for a more comprehensive approach from the beginning. A recent German consortium studying links between atopic dermatitis and cardiovascular disease first screened a large claims database, followed by analyses of more deeply phenotyped (birth) cohorts with longitudinal data. In addition, genetic and metabolic analyses assessing the predisposition of patients with atopic dermatitis for cardiovascular disease were performed. Overall, the association between atopic dermatitis and cardiovascular disease was at most modest, but in more refined cohorts the cardiovascular risk profile and genetic architecture was comparable. A more integrated approach could create clarity about the clinical relevance of cardiovascular disease in individuals with atopic dermatitis sooner, avoid speculation that affects patient care, and save scientific resources.