Related Cardiovascular Disease Risk Factors Research Articles

Relationships between different trends of the Mediterranean diet and cardiovascular disease-related risk factors in China: results from the CHNS study, 1997–2009

Relationships between different trends of the Mediterranean diet and cardiovascular disease-related risk factors in China: results from the CHNS study, 1997–2009

Green Streets, Healthy Hearts: Exploring the Roles of Urban Nature and Walkability in Cardiovascular Health.

With the growing evidence that connects urban environments with public health outcomes, the role of urban planning has become increasingly critical in addressing public health challenges. Cardiovascular diseases (CVDs) are the leading cause of mortality in urban areas and worldwide and are impacted by characteristics of the built environment, such as walkability and nature exposure. In this literature view, we explore the influence of the physical built environment, specifically green spaces and walkability, on cardiovascular health. Results from prior studies show a clear reduction in cardiovascular disease-related risk factors, morbidity, and mortality in neighborhoods that integrate green spaces and/or walkability. Cumulative evidence suggests that urban environments that integrate green spaces (such as parks) and walkability (eg, safe sidewalks) can significantly improve cardiovascular health. Urban planning policies and strategies that prioritize the integration of green infrastructure and walkable designs can contribute to improving cardiovascular health in urban residents while also enhancing the overall well-being and quality of life.

Oral health related cardiovascular disease risk factors: a cross-sectional study

Abstract Background Hypertension, cardiovascular disorders, and hypercholesterolemia represent significant public health concerns. This research presentation examines the impact of various oral health indicators, such as bleeding gums, untreated dental decay, loose teeth, and missing teeth, on these conditions within Hungary. Materials and methods This study utilized data from 5,603 individuals participating in the 2019 Hungarian European Health Interview Survey. Predictor variables were chosen using elastic net regularization and k-fold cross-validation to enhance the performance of weighted logistic regression models. Sensitivity analysis underpinned the robustness of the results. Results Significant associations emerged between deteriorating oral health and the prevalence of various cardiovascular conditions. An increased likelihood of hypertension was observed in individuals with multiple tooth removals, showing an odds ratio (OR) of 1.67 with a 95% confidence interval (CI) of [1.01-2.77]. The use of dental prosthetics presented an OR of 1.45 [1.20-1.75]. Additionally, presence of gum bleeding corresponded to elevated odds for both cardiovascular disease (OR = 1.69 [1.30-2.21]) and hypercholesterolemia (OR = 1.40 [1.09-1.81]). Conclusions enhancing oral health could potentially mitigate chronic cardiac conditions, highlighting the importance of integrating dental care in comprehensive disease management strategies. Key messages • Poor oral health is linked to higher hypertension and heart disease odds. • Dental care is crucial in cardiac disease prevention and management.

The prevalence of the risk factors associated with cardiovascular diseases among Iranian adults: Findings of a cross-sectional study.

Cardiovascular diseases are among the leading causes of death worldwide. Lack of accurate estimation of the risk factors associated with these diseases can impair the designing of effective interventions in this field; the present study aimed to investigate the risk factors attributable to cardiovascular diseases in males and females visiting comprehensive health service centers in 2018. This cross-sectional study is part of the national health transformation plan shaped in response to the emerging epidemic of noncommunicable diseases. In the present study, 6,331 participants aged 30 years and older were randomly and census selected from comprehensive urban and rural health service centers in Naein County, in Isfahan, Iran, respectively. The data were collected using the electronic health record from the IraPEN program in two sections: demographic information and the prevalence of cardiovascular disease risk factors. They were then analyzed with Statistical Package for the Social Sciences (SPSS) 24 software using descriptive statistics, Chi-square test, one-way ANOVA, and logistic regression. The participants' mean age was 55.09 ± 16.11 years. The main risk factor was insufficient consumption of fruits and vegetables while smoking was a negligible risk factor. Low physical activity, diabetes, hypertension, hypercholesterolemia, and high body mass index were more prevalent in females than in males, whereas smoking was more frequently reported in males (P < 0.001). Risk factors such as age, gender, education level, place of residence, and marital status, played a significant role in determining CVD risk factors. More than half of Iranian adults had one or older cardiovascular disease-related risk factors, and the prevalence of such factors was higher in females than in males. Given the importance of gender differences in cardiovascular disease-related health habits, it is necessary to reduce the majority of these diseases in society, especially in women, by controlling modifiable risk factors.

Longitudinal trends in physical activity levels and lifetime cardiovascular disease risk: insights from the ATTICA cohort study (2002-2022).

To evaluate trends in physical activity levels and their associations with demographic characteristics, health status, and lifetime cardiovascular disease (CVD) risk. A longitudinal analysis was conducted using data from 987 males and 1,001 females (45 ± 12 years old) participating in the ATTICA cohort study. Physical activity levels were assessed at baseline (2001-2002) and subsequent follow-ups (2006, 2012, and 2022). Four physical activity trajectories according to participants' physical activity tracking were defined, i.e., consistently active/inactive and changed from active/inactive. Twenty-year incidence of hypertension, hypercholesterolemia, and diabetes were evaluated in relation to physical activity trajectories; the life-table method was utilized to forecast the lifetime CVD risk (death without CVD was regarded as a competing event). in total, 47% of the participants were categorized as being consistently inactive, whereas only 9% of males and 15% of females sustained physical activity levels throughout the 20-year follow-up period (p < 0.001). Participants being consistently inactive were from lower socioeconomic backgrounds (p = 0.002). Transitioning to being physically active was associated with higher education level and being married (p < 0.001). Consistently active individuals had up to 35% reduced lifetime CVD risk, and lower 20-year incidence of hypertension, and hypercholesterolemia (p < 0.01); no association was observed regarding diabetes incidence. Promoting and maintaining regular physical activity throughout lifespan is crucial for reducing lifetime CVD risk and related risk factors. Tailored interventions addressing demographic and socioeconomic factors may help enhance cardiovascular health outcomes.

Vitamin K1 intake is associated with lower risk for all-cause and cardiovascular disease mortality in community-dwelling older Australian women

Background and aimsAssessing the relationship between vitamin K1 intakes, using region-specific food databases, with both all-cause, and cardiovascular disease (CVD) mortality warrants further investigation to inform future preventative strategies. Consequently, we examined the aforementioned associations in the Perth Longitudinal Study of Ageing Women (PLSAW). Methods and results1436 community-dwelling older Australian women (mean ± SD age 75.2 ± 2.7 years) completed a validated food frequency questionnaire at baseline (1998). Vitamin K1 intake was calculated based on an Australian vitamin K food database, supplemented with published data. All-cause and CVD mortality data was obtained from linked health records. Associations were examined using restricted cubic splines within Cox-proportional hazard models, adjusted for a range of cardiovascular and lifestyle related risk factors. Over 15 years of follow-up, 601 (41.9%) women died, with 236 deaths (16.4%) due to CVD. Compared to women with the lowest vitamin K1 intakes (Quartile 1, median 49.1 μg/day), those with the highest intakes (Quartile 4, median 119.3 μg/day) had lower relative hazards for all-cause mortality (HR 0.66 95%CI 0.51–0.86) and CVD mortality (HR 0.61 95%CI 0.41–0.92). A plateau in the inverse association was observed from vitamin K1 intakes of approximately ≥80 μg/day. ConclusionHigher vitamin K1 intakes were associated with lower risk for both all-cause and CVD mortality in community-dwelling older women, independent of CVD related risk factors. A higher intake of vitamin K1 rich foods, such as leafy green vegetables, may support cardiovascular health.

#6643 MOLECULAR PATHWAYS ASSOCIATED WITH VASCULAR CALCIFICATIONS IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Patients with advanced stages of chronic disease (CKD) suffer from 30-times higher risk of cardiovascular disease (CVD) as compared to the general population, vascular calcifications are prevalent. Underlying molecular mechanisms are only partly understood. Children are devoid of life-style and aging related CVD risk factors and therefore allow for a highly sensitive and specific analyses of CKD induced pathomechanisms. Method Arteriolar tissues of 55 children with normal renal function and 29 children with CKD5 (median age 9.2 years) underwent digital histomorphometry, calcium deposits were assessed by Von Kossa staining and 18F-sodium fluoride positron emission tomography (18F-NaF PET). Gene set enrichment (GSEA) and Ingenuity pathway analysis were performed on multi-omics data sets obtained from micro-dissected omental arterioles from children with normal renal function and with CKD5 (n = 7/group; age 7.3 ± 3/6.8 ± 3 years). Based on literature review, we established a vascular calcification (VC) pathway library comprising 442 biological processes/molecular functions and extracted linked genes from Gene Ontology database. Key identified mechanisms were validated in independent patient cohorts (n = 32) and controls (n = 20) by quantitative immunostaining. Results Significant arteriolar lumen obliteration was present in CKD5 children (p = 0.001), intima and media thickness were increased (p&amp;lt;0.0001 and p = 0.02). Von Kossa staining was negative, but 18F-NaF PET revealed microcalcifications in children with CKD5. Subendothelial arteriolar inflammatory cells (CD68+ macrophages) were present in CKD5 cohort (p&amp;lt;0.0001 compared to non-CKD controls) and correlated with serum inorganic phosphorus (R2 = 0.18; p = 0.04). GSEA identified top enriched pathways including telomere extension by telomerase and chromatin histone methylation. IPA cross-omics showed suppression of actin cytoskeleton, tight junction signaling, and focal adhesion. VC pathway analysis identified 30/442 pathways related to actin cytoskeleton, Wnt signaling, extracellular matrix (ECM) organization, complement activation, apoptosis, endoplasmic reticulum stress and ossification regulation. Fibronectin-1 (FN1) was identified as Hubgene, involved in ECM regulation. In independent age-matched cohorts, complement factor C3d was higher in CKD5, vascular endothelial growth factor and endothelial cell number/µm endoluminal circumference were reduced. Arteriolar osteoglycin, a protein inducing ectopic bone formation, was increased and correlated with serum PTH (R2 = 0.61; p = 0.01). FN1 was less abundant in arterioles from CKD5 children and negatively correlated with serum creatinine levels (R2 = −0.62; p = 0.02). Conclusion Vascular disease and microcalcifications are present in young children with CKD5. We provide the first comprehensive analysis of the underlying molecular mechanisms associated with the vascular calcifications and identified specific molecular pathomechanisms, of which several represent potential therapeutic targets.

The association between adverse childhood experiences and metabolic syndrome in severe mental illness: A literature review.

A history of adverse childhood experiences (ACE) is common among people with severe mental illness (SMI), and they are also associated with physical health problems, including metabolic syndrome (MetS) in general adult populations. We aimed to evaluate and synthesise the evidence relating to the association between ACE and MetS and/or its components in patients with SMI. We systematically searched multiple databases (MEDLINE, PubMed, PsycINFO, EMBASE, Emcare, Cochrane Library, Health Technology Assessments, Joanna Briggs Institute, and Maternity and Infant Care database) and reviewed studies that described an association between ACE and MetS or its components in SMI adult patients. Twenty studies were reviewed. Most studies described a significant association between ACE and at least one to three components of MetS, with obesity being the most studied and, therefore, showing a more consistent association compared to the other MetS components. ACE and the components of MetS did not remain significant, in most of the studies, after adjusting for confounders. None of the studies showed an association with MetS as a whole entity. Adults with SMI with a history of ACE are more likely to demonstrate health problems such as MetS and cardiovascular disease-related risk factors.

Abstract 14568: Recognition of Cardiovascular Disease Related Risk Factors, Eligibility and Completion of Recommended Health Checks Among Australian Adults

Introduction: Cardiovascular disease (CVD) is a leading cause of death in women globally. Risk factors include hypertension (HTN), hyperlipidaemia, high body mass index (BMI), diabetes, poor mental health and health literacy. Early identification and management of risk factors is imperative, given that CVD in women is often under-recognised. Methods: Using selected social media platforms a survey was conducted among adult Australians (&gt;18yrs) in 2019, evaluating knowledge of risk factors for CVD, eligibility and completion of Australian Guideline recommended health checks. Results: Amongst 229 respondents 77% (177/229) were women. 62% of women (111/177) and 71% of men (37/52) were under the age of 44 years. Women reported a mean of 5/12 risk factors and men reported a mean of 7/12 risk factors for CVD. Women were more likely to report family history compared to men (29.3%, 52/177; vs 9.61%, 5/52; p=0.001), hyperlipidaemia (29.3%, 52/177; vs 11.5%, 6/52; p=0.004), high BMI (37.85%, 67/177 vs 23%, 12/52 p=0.002), HTN (18%, 32/177; vs 5.76%, 3/52; p=0.015) and an unhealthy diet (35%, 62/177; vs 27%, 14/52; p=0.1382). Women were less likely to report inactivity (33% 59/177, vs 36.5%, 19.52; p=0.334). Smoking was the most frequently reported risk factor by both sexes (40.3%, 74/177 and 41.8%, 21/52; p=0.427). Fewer women were aware of eligibility for a blood pressure check (9.6%, 17/177; vs 11.5%, 6/52; p=0.341), cholesterol (13%, 9/66; vs 33%, 5/15; p=0.034) and weight check (0%, 0/177; vs 2%, 1/52; p=0.033). Awareness of eligibility for a diabetes check was similar between the sexes (12%, 8/66 in women vs 11%, 1/15 in men; p=0.272). More women had completed a blood pressure (71%, 126/177; vs 65%, 32/52; p=0.093) and weight check (34%, 61/177; vs 32%, 17/52; p=0.406) than men however less women had completed a cholesterol (52%, 34/66; vs 60%, 9/15; p=0.276) and diabetes check (21%, 14/66; vs 33%, 5/15; p=0.159). Conclusion: This pilot study found that knowledge of CVD risk factors and eligibility for health checks was low &amp; risk factor profiles differed significantly between the sexes. Future studies evaluating a larger cohort are needed to further assess the significance of sex-based differences in awareness to risk factors, eligibility and completion of health checks.

The Correlation between Type 2 Diabetes Mellitus and Cardiovascular Disease Risk Factors in the Elderly.

With the improvement of people's living conditions and changes in social lifestyles, the incidence of type 2 diabetes is gradually increasing, and the number of people with diabetes and cardiovascular disease is also increasing. Based on this, the article collects basic information on 650 elderly patients with type 2 diabetes, of which 49.39% are between 60 and 70 years old, 32.46% are between 70 and 80 years old, and 18.15% are between 80 and 90 years old. Through the analysis of related cardiovascular disease risk factors, the correlation between the elderly cardiovascular disease risk factors and type 2 diabetes is explored. The results showed that the correlations between smoking history, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and the risk of type 2 diabetes in the elderly were 0.987, 0.956, 0.971, and 0.940, respectively. It can be seen that these factors are highly correlated with the risk of type 2 diabetes in the elderly, and smoking history has the strongest correlation, indicating that high levels of smoking may be a key pathogenic factor in the onset of type 2 diabetes. The correlation of other factors is lower than 0.8, indicating that other factors are additional risk factors for the disease. After that, the p value was 0.01, and the difference test was passed, which proved the accuracy of the model.

Use of YouTube to watch health-related videos and participation in online support groups among US adults with heart disease, diabetes, and hypertension.

ObjectiveSocial media use has grown over time. However, it is unclear how people with a self-reported history of cardiovascular disease or cardiovascular disease-related risk factors such as diabetes and hypertension use social media.MethodsData from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were analyzed (N = 3865). Only respondents with complete data for all variables of interest were included in the analyses, resulting in 306 respondents with a heart condition, 1291 with hypertension, and 608 with diabetes. We explored associations between two dependent variables: (1) participated in an online forum or support group and (2) watched a health-related video on YouTube, and sociodemographic factors and patient-provider communication. Analyses were conducted separately by medical condition. Odds ratios, 95% confidence intervals, and p-values were calculated.ResultsIn respondents with a heart condition, hypertension, or diabetes, 5.4%, 8.4%, and 10.3% had participated in an online support group and 29.6%, 40.4%, and 36.6% had watched health-related videos on YouTube, respectively. Univariately, the odds of using online support groups was associated with younger age (vs. > = 65) in people with a heart condition and hypertension, but not diabetes. Regarding YouTube, younger age was associated with watching health-related videos across all three medical conditions, with additional gender and education associations observed in those with hypertension. There were no associations between social media use and patient-provider communication.ConclusionsThese findings may inform the selection of social media platforms for behavioral interventions depending on the intended patient population and goals (e.g. social support vs. video-based health education).

EHealth interventions for reducing cardiovascular disease risk in men: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy (DfE) studentships Background. Men remain at a higher risk of developing cardiovascular disease (CVD) than women and behavioral risk factor modification is an important preventive measure. However, engaging men in behavior change interventions is challenging. eHealth interventions have the potential to address this gap, though their effectiveness for reducing CVD risk in men is unclear. Purpose. To conduct a systematic review and meta-analysis to evaluate the effectiveness of eHealth interventions for reducing CVD risk in men. Methods. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and principles laid out by the Cochrane Handbook for Systematic Reviews of Interventions. A search of published randomised controlled trials (RCTs) with no date restrictions up to July 2020 was conducted across five electronic databases: Cochrane Central register of Controlled Trials (CENTRAL), Medline, CINAHL Plus, PsycINFO and SCOPUS. Reference lists of relevant systematic reviews and meta-analyses were manually searched for additional trials not identified during the database search. Eligible studies were RCTs that focused on the use of eHealth to improve a minimum of two major CVD related risk factors in males aged 18 years or older. Results. A total of 3168 records were retrieved from the online database search, with nine trials meeting the inclusion criteria following screening and full-text assessment. Study quality ranged from low to unclear, with one trial at a high risk of bias. Compared to those in a control group or receiving printed materials, participants randomised to an eHealth intervention had statistically significant improvements in BMI (Z=-2.75, p = 0.01), body weight (Z=-3.25, p = 0.01), waist circumference (Z=-2.30, p = 0.02) and systolic (Z=-3.57, p = 0.01) and diastolic (Z=-3.56, p = 0.01) blood pressure. Though less evident, there were also improvements in physical activity and diet in favour of the intervention group. Conclusion. This was the first systematic review and meta-analysis conducted on the effectiveness of eHealth interventions for reducing CVD risk in men. This review suggests that eHealth interventions can reduce CVD risk in adult men through behavior change. However, we were unable to determine the association between intervention characteristics and outcomes. Also, overall, participant adherence to the intervention was poor. Both of these issues should be considered in future studies.

Sex Differences in Cardiovascular Disease and Cognitive Dysfunction in Rural West Elderly Texans.

Background:The prevalence of cognitive dysfunction increases in elderly due to cardiovascular disease related risk factors in rural communities like West Texas.Objective:The purpose of this study was to find risk factors of cardiovascular disease (CVD) related to cognitive dysfunction and their impact on elderly adults in rural West Texans.Methods:Statistical methods such as Pearson’s chi-squared and a multinomial logistic regression were utilized to analyze data. We used SPSS software to detect and understand the nature of the risk factors.Results:A summary of statistics was obtained by using Pearson’s chi-squared test for categorical variables. CVD, diabetes mellitus, and depression were significantly associated with cognitive dysfunction for both males and females (p = 0.0001), whereas anxiety was found to be significantly associated with cognitive dysfunction for females (p = 0.0001). Age group and race/ethnicity were significantly associated with cognitive dysfunction for both males and females (p = 0.0001). By performing a multinomial logistic regression method and controlling for confounders, the significant risk factors (p < 0.05)— age (65– 84 years), diabetes, and memory loss for age-associated cognitive impairment; diabetes for cognitive impairment no dementia; age (65– 84, ≥85 years), CVD, diabetes, depression, memory loss, non-Hispanic Whites, and Black/African-Americans for mild cognitive impairment; and age, memory loss, non-Hispanic Whites, Black/African-Americans, and male gender were found for dementia.Conclusion:CVD related risk factors in developing cognitive dysfunction exist and integrating such risk variables may guide relevant policy interventions to reduce Alzheimer’s incidence or dementia in rural communities in West Texans.

Use of proton pump inhibitors is associated with lower rates of first-time ischemic stroke in community-dwelling elderly.

Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first-time ischemic stroke (FTIS) among elderly. The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002-2016) for community-dwelling individuals (≥65-95 years) for demographics and co-morbidities. Follow-up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS. 29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65-95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non-users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69-0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non-users (HR 0.9, 95% C.I. 0.85-0.96 for 7-48 yearly prescriptions and HR 0.51, 95% C.I. 0.46-0.55 for ≥49 yearly prescriptions). PPI use was associated with lower rates of FTIS in community-dwelling elders. Prospective large-scale studies are needed to fully elucidate the effect of PPI in this aging population.

Asymmetric dimethylarginine compartmental behavior during high-flux hemodialysis

Aim The accumulation of uremic toxins, such as asymmetric dimethylarginine (ADMA), has emerged as one of the major cardiovascular disease-related risk factors in patients with end-stage renal disease (ESRD). Based on the low molecular weight of ADMA, hemodialysis (HD) should theoretically effectively remove ADMA. In this study, we investigated the clearance behavior of ADMA during high-flux HD. Methods Eight HD patients without residual renal function were included. Blood samples were collected at 0, 30, 60, 120 and 240 min after dialysis started, as well as 1 h and 48 h after dialysis. ADMA level was detected by HPLC-MS/MS. Herein, the ADMA level in blood cells and the ADMA protein binding rate were measured. Accordingly, the dialyzer extraction ratio was also determined. Results The reduction ratio (RR) of ADMA (corrected for hemoconcentration) was significantly lower, at only 37.21 ± 6.44%, than that of urea and creatinine (p < .05). Interestingly, its clearance from plasma was precipitous early in dialysis and became slowly from 60 to 240 min. Additionally, a greater inlet erythrocyte than plasma concentration was found for ADMA. The dialyzer extraction ratio was comparable between ADMA and creatinine or urea (83 ± 5% for ADMA vs. 84 ± 3% and 88 ± 2% for creatinine and urea, respectively; both p>.05). Urea and creatinine had a slight rebound ratio of less than 10% at 1 h after the completion of HD. In contrast, considerable rebound of approximately 30% was detected in ADMA. Conclusion This study suggests that ADMA may present a multicompartmental distribution that cannot be representatively reflected by the urea kinetics model.

A study on prevalence of cardiovascular disease related risk factors among tribal population in a block of West Bengal

Background: Non communicable diseases (NCDs) refer to chronic diseases of long duration and generally with slow progression. NCDs are affecting Indian population, both in urban and rural areas. Cardiovascular disease (CVD), one of the major NCDs is the leading cause of death worldwide. The rising prevalence of behavioral and anthropometric risk factors for these lifestyle diseases is postulated to be the cause for the alarming increase of NCDs including CVD. Prevalence of cardiovascular diseases is also increasing in tribal population. Objective of this study was to assess the prevalence of risk factors associated with cardiovascular diseases among the tribal population aged 18 years and above.Methods: A community based, observational, descriptive study was conducted at Kharagpur-II block of Paschim Medinipur district, West Bengal from August 2013 to July 2014 among 540 tribal population aged 18 years and above selected by cluster random sampling method.Results: About 64% individuals were addicted to tobacco product. Prevalence of current smoking and tobacco chewing was 9.1% and 60.2% respectively. Prevalence of current alcohol consumption was 48.9%. About 91% individuals took extra salt with meal. Prevalence of overweight and obesity was 7.8% and 3.5% only according to WHO recommended classification for Asian population. However, higher level of physical activity was found among the study population.Conclusions: The study revealed high prevalence of extra salt intake, tobacco and alcohol consumption among the study population which may endanger their life by increasing the risk of cardiovascular disease.

Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis.

BackgroundThere is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors.Methods and findingsWe took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992–2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971–2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β −0.036, 95%CI: −0.06, −0.02, p < 0.01; NHANES β −0.032, 95%CI: −0.05, −0.02, p < 0.01), depression (HRS β −0.049, 95%CI: −0.07, −0.03, p < 0.01), triglycerides (NHANES β −0.039, 95%CI: −0.06, −0.01, p < 0.01), and heart disease (HRS β −0.025, 95%CI: −0.04, −0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts.ConclusionsThis study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.

Abstract P268: Long and Short Sleep and Obesity in the Women’s Health Study

Background: Although evidence suggests that extremes of sleep (i.e. long and short) are associated with cardiovascular disease-related risk factors in the general population, research examining the association between the extremes of sleep and obesity in older women is limited. Methods and Results: We used the Women’s Health Study (WHS) 2012-2013 follow-up cohort of 21,726 older women (mean age = 72.1 ± 6.0 years old) to examine the cross-sectional association between extremes of sleep and obesity. Women with cancer or missing body mass index (BMI) data were excluded. Long sleep was defined as &gt; 9 hours/day, short sleep as &lt; 6 hours/day, and sleep of 6-9 hours/day was the reference. Sleep duration and BMI were self-reported measures. Approximately 23.3% of women were obese (BMI ≥ 30 kg/m 2 ). Overall, women who were obese and had either long or short sleep were less likely to exercise, and more likely to have history of diabetes, depression symptoms, and lower education and income levels. Women who were obese and long sleepers were more likely to use alcohol and have history of hypertension, while short sleepers were more likely to be current smokers. Logistic regression analyses revealed that older women with long sleep and short sleep had 30% higher odds of obesity, respectively, compared to women who slept 6-9 hours, adjusting for age and race/ethnicity. These relationships were attenuated and lost significance when controlling for potential important confounders (Table 1). Conclusion: Older women reporting extremes of sleep had higher odds of obesity compared to women who sleep 6-9 hours, after control for age and race/ethnicity. Further adjustment for traditional cardiovascular risk factors and socioeconomic parameters resulted in loss of significance.

Hypertensive pregnancy disorders increase the risk of maternal cardiovascular disease after adjustment for cardiovascular risk factors

Background and aimHypertensive pregnancy disorders are associated with subsequent cardiovascular disease (CVD), but the extent to which this association is explained by shared risk factors is unknown. We aimed to evaluate whether hypertensive pregnancy disorder in first pregnancy is associated with increased subsequent risk of maternal CVD after adjustment for established CVD risk factors measured after pregnancy. Methods and resultsA total of 20,075 women with a first delivery registered in the Medical Birth Registry of Norway (1980–2003) participated in Cohort of Norway (CONOR) health surveys a mean (standard deviation) of 10.7 (5.5) years after delivery. They were then followed (median 11.4 years) for an incident fatal or non-fatal CVD event through linkage to the Cardiovascular Disease in Norway (CVDNOR) database and the Norwegian Cause of Death Registry. Hypertensive pregnancy disorders were associated with an increased risk of CVD [Hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.9–2.8], which remained significant after adjustment for established CVD risk factors including body mass index, smoking, hypertension, diabetes, serum glucose and lipid levels (HR 1.5; 95% CI 1.2–1.8). The population attributable fraction of CVD due to hypertensive pregnancy disorder was 4.3% (95% CI 1.9–6.6) after multivariable adjustment. ConclusionThe association between hypertensive pregnancy disorders and CVD risk was mediated in part by related CVD risk factors measured 10 years following delivery. These results underline the importance of post-pregnancy follow-up of women with hypertensive pregnancy disorders focusing on modifiable, lifestyle related risk factors to prevent future CVD.

PO248 Prevalence of Dyslipidemia Among Adults In Himalayan Mountain Villages: Role of High Altitude

To examine the prevalence of obesity and related cardiovascular disease risk factors among Tibetan immigrants living in high altitude areas.A total of 149 Tibetan immigrants aged 20 years and over were recruited in 2016 in Ladakh, India. Anthropometric indices and biochemical factors were measured. Using the provided Asia-Pacific criteria from the World Health Organization, overweight and obese status were determined. Metabolic syndrome (MetS) was defined according to the American Heart Association.In general, men were older, taller, and had a greater amount of fasting glucose, and uric acid when compared to women. The prevalence of overweight, general obesity, and central obesity was 23.4, 42.6, and 42.6% in men and 7.8, 64.7, and 69.6% in women, respectively. The prevalence of MetS was 10.6% in men and 33.3% in women, respectively. In older subjects, the prevalence of obesity and MetS was found to be greater. In both genders, the prevalence of hypertension, central obesity, and MetS was significantly different among these body mass index (BMI) groups. Compared to the non-central obesity group, the central obesity group has higher weight, BMI, body fat, hip circumference, systolic and diastolic BP, and prevalence of hypertension. No relationship was found between the prevalence of diabetes and fasting glucose and BMI groups or central obesity groups in both genders.Among this group of Tibetan immigrants living in high altitude areas, women have a higher prevalence of obesity and MetS than men. No relationship was found between diabetes and obesity.