Assessment Of Cardiovascular Disease Risk Factors Research Articles

Cardiovascular risk assessment: Missing albuminuria contributing to gender inequality

IntroductionChronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk.The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations.We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD. MethodsObservational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data. ResultsAmong 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91±21.4 years; 261,694 (36.9%) were older than 50 years.Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women.Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58–87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women.Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31–47% for other CVD risk factors.Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed. ConclusionAlbuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women.

"There could be something going wrong and I wouldn't even know": a qualitative study of perceptions of people with cancer about cardiovascular disease (CVD) risk and its management.

Despite being at higher risk, many people with cancer do not receive adequate cardiovascular disease (CVD) risk assessment or management. The purpose of this research was to examine people with cancer's perceptions, experiences and needs regarding CVD risk factor awareness, assessment and management. We conducted 15 individual interviews to examine people with cancer's perspectives regarding CVD care in cancer. Reflexive thematic analysis was utilised to collect and organise data into themes and to synthesise findings. Fifteen people (6 males) diagnosed with diverse cancer types participated. Majority participants were not or only somewhat aware of CVD risk in cancer, but all expressed it was an important issue. A diverse range of priorities and needs for CVD care was discussed, including some participants' prioritisation of dealing with cancer and preferred amount, type and manner of information provision and support. Websites and brochures were identified as potential solutions for optimising CVD care. Codesign methodology should be used to engage patients in the development of flexible, tailored resources to increase awareness of CVD risk and strategies for its management. Perceptions of people with cancer regarding CVD care can inform new interventions that reduce the impact of CVD in cancer.

Adaptive and Compensatory Mechanisms of the Cardiovascular System and Disease Risk Factors in Young Males and Females

Background: Cardiovascular disease (CVD) is increasing dramatically in young people and is the leading cause of death worldwide. Aims: This study aimed to evaluate differences in the adaptive and compensatory mechanisms of the cardiovascular system (CVS) in young men and women to determine the most significant risk factors and assess the stability of the non-invasive method used in the early detection of CVD risk factors in young people. Objectives: Currently, early evaluation of CVD risk factors is possible only through invasive methods, such as the Framingham risk score and the SCORE chart. Therefore, the development of a more flexible and non-invasive method is crucial in large populations. Methods: A cohort cross-sectional investigation examined 173 volunteers, divided into two groups according to gender (n1 female=83, n2 male=90), and their heart rate, blood pressure (SBP/DBP), height, weight, and waist and hip circumference were non-invasively measured. Then, the potential adaptation value (R.M. Baevsky et al., 1987), Martinet test (MT), body mass index (BMI), and waist/hip ratio were calculated. Moreover, we collected information on lifestyle risk factors, including tobacco smoking, alcohol consumption, factors related to unhealthy diet, lack of physical activity, sleep deprivation, and anxiety, through special in-person interviews using paper/online questionnaires. The T-test and the x2 tests were applied for statistical analysis. Results: Impaired/pathological cardiovascular adaptation was observed in 11.54% of the female group and 46.07% of the male group. In the female group, cardiovascular recovery abnormalities were observed in the SBP, DBP, and HR MT in 20.59%, 16.18%, and 44.12%, respectively, whereas in the male group, 32.50%, 21.25% and 36.25%, respectively. Despite gender, these deviations were accompanied by the prevalence of sympathetic influences in the regulation of CVS functions in 72.73% of the first group and 69.66% of the second group. BMI was violated in 47.19% of males and 29.49% of females. The test results were identical to that in the invasive methods of assessment of CVD risk factors. Conclusion: Abnormalities in cardiovascular adaptation mechanisms in young women are less pronounced. Gender-dependent risk factors have high yields, such as obesity, low physical activity, and hypertension, which are more pronounced in men. The usability of the test requires further investigation on a larger sample.

Reducing the impact of cardiovascular disease in older people with cancer: a qualitative study of healthcare providers

PurposeCancer survivors are at greater risk of cardiovascular disease (CVD) than cancer-free controls. Despite evidence-based guidelines recommending CVD risk factor assessment, surveillance and risk-reduction, many people with cancer do not receive adequate CVD care. To address potential barriers and enablers of care, we examined healthcare professionals’ (HCPs) perceptions and experiences of CVD risk assessment and management in people with cancer.MethodsWe conducted one focus group and 12 individual interviews to examine HCPs’ perceptions and experiences of CVD care in care. We used reflexive thematic analysis to collect and analyse the qualitative data to construct and understand themes.ResultsTwenty-one HCPs participated (8 oncologists, 5 nurses, 3 general practitioners, 2 dietitians, 1 cardiologist, 1 haematologist and 1 physiotherapist). Majority of HCPs were aware of CVD risk in cancer but were concerned they could not deliver CVD care alone due to system-level barriers including lack of time and training. HCPs also perceived patient-level barriers including socioeconomic disadvantage and fatalistic outlook. Despite barriers, HCPs suggested diverse solutions for improving CVD care in cancer including new models-of-care, clinical pathways, risk assessment/management tools and education.ConclusionsThe diversity of perceived barriers and suggested solutions identified by HCPs suggests the need for a multilevel approach tailored to context. Future research involving people with cancer is needed to co-design acceptable interventions.Implications for Cancer SurvivorsImproved understanding of HCP’s perceptions can inform the development of new interventions to deliver CVD care to people with cancer to reduce morbidity and mortality.

Risk Factor Assessment in Virtual Cardiac Rehabilitation Amid the Covid-19 Pandemic.

Risk Factor Assessment in Virtual Cardiac Rehabilitation Amid the Covid-19 Pandemic.

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

Assessment and management of cardiovascular risk factors among U.S. Veterans with newly diagnosed prostate cancer.

5510 Background: Cardiovascular disease (CVD) is a leading cause of death in men with prostate cancer (PC). Androgen deprivation therapy (ADT) is associated with increased CVD risk, and American Heart Association guidelines recommend CVD risk factor assessment and management in PC patients starting ADT. We characterized rates of guideline-concordant assessment and management of CVD risk factors for US Veterans with newly diagnosed PC, according to ADT use and prior atherosclerotic CVD diagnosis. Methods: We used cross-sectional data from VA Corporate Data Warehouse to identify Veterans with an incident diagnosis of PC from 2001-2017. Primary outcomes were guideline-concordant baseline CVD risk factor assessment (defined as ≥1 blood pressure, cholesterol, and HbA1c or fasting glucose measurement within 1 year prior to 6 months after ADT start or PC diagnosis), CVD risk factor control, and CVD risk-reducing medication use. Risk difference multivariable regression analyses adjusting for age, race, poverty, PC risk category, and year were used to evaluate the effect of ADT on study outcomes. Results: Of 191,829 Veterans with newly diagnosed PC, 27% (n = 51,419) were treated with ADT within 1 year of diagnosis, and 18% (n = 34,110) had a pre-existing diagnosis of atherosclerotic CVD. From 2001-2017, annual rates of guideline-concordant CVD risk factor assessment increased from 26% to 77%. In adjusted analyses, pre-existing atherosclerotic CVD diagnosis was associated with higher CVD risk factor assessment rate (64% vs 53%), better control of baseline LDL (94 vs 108 mg/dL), and higher rates of anti-hypertensive (90% vs 66%), lipid-lowering (83% vs 49%), and glucose-lowering (32% vs 20%) medication use. Treatment with ADT was associated with similar to minimally higher rates of CVD risk factor assessment (58% vs 54%), LDL control (104 vs 105 mg/dL), and anti-hypertensive (73% vs 69%), lipid-lowering (55% vs 55%), and glucose-lowering (25% vs 21%) medication use. Sixty percent of men starting ADT had at least one sub-optimally controlled CVD risk factor, and 1 in 4 of these men were not receiving a corresponding risk-reducing medication. One third of men starting ADT had BMI &gt; 30 kg/m2. Conclusions: CVD risk factor assessment in Veterans with PC has increased over time. However, ADT does not appear to meaningfully impact CVD assessment or management, despite its known association with CVD risk. Over half of patients initiating ADT had elevated CVD risk factor(s). Multi-disciplinary efforts to improve CVD risk mitigation are needed among men initiating ADT.

Evaluating the use of the heart age tool in community pharmacies: a 4-week cluster-randomized controlled trial.

Joint British Societies have developed a tool that utilizes information on cardiovascular disease (CVD) risk factors to estimate an individual's 'heart age'. We studied if using heart age as an add-on to conventional risk communication could enhance the motivation for adapting to a healthier lifestyle resulting in improved whole-blood cholesterol and omega-3 status after 4 weeks. A total of 48 community pharmacies were cluster-randomized to use heart age+conventional risk communication (intervention) or only conventional risk communication (control) in 378 subjects after CVD risk-factor assessment. Dried blood spots were obtained with a 4-week interval to assay whole-blood cholesterol and omega-3 fatty acids. We also explored pharmacy-staff's (n=27) perceived utility of the heart age tool. Subjects in the intervention pharmacies (n=137) had mean heart age 64 years and chorological age 60 years. In these, cholesterol decreased by median (interquartile range) -0.10 (-0.40, 0.35)mmol/l. Cholesterol decreased by -0.20 (-0.70, 0.30)mmol/l (P difference =0.24) in subjects in the control pharmacies (n=120) with mean chronological age 60 years. We observed increased concentrations of omega-3 fatty acids after 4 weeks, non-differentially between groups. Pharmacy-staff (n=27) agreed that heart age was a good way to communicate CVD risk, and most (n=25) agreed that it appeared to motivate individuals to reduce elevated CVD risk factors. The heart age tool was considered a convenient and motivating communication tool by pharmacy-staff. Nevertheless, communicating CVD risk as heart age was not more effective than conventional risk communication alone in reducing whole-blood cholesterol levels and improving omega-3 status.

Promoting Cardiovascular Health in Midlife Women

Cardiovascular disease (CVD) remains the number one cause of death in the USA. In women, coronary heart disease (CHD) accounts for 22% of deaths with an additional 6.2% of deaths secondary to stroke. The prevalence of CVD increases as women age; after the age of 75, the incidence will exceed that reported for men. The risk for CVD in women is systematically underestimated. Both healthcare providers and women need a better understanding of the mechanism and role of traditional CVD risk factors (CVDRF) in women, and the newer identified non-traditional CVDRF which are unique to women and the resulting CVD morbidity and mortality. Women with a CVD event often do not present the same as men. During middle-age and the transition to post-menopause, the complaints women experience often do not match the standard male-oriented CVD symptoms, and thus are often erroneously attributed to menopause. Unique sex-gene expression and function account for the biological variances in both CVDRF and CVD prevalence and presentation in women. There is a need for a more sex-specific approach to CVDRF assessment and targeted reduction in women. There are major differences in the risk, development, and presentation of CVD in women. A wide-spread awareness is lacking in women and healthcare providers of the unique sex-specific differences in both CVDRF and CVD in women. The traditional CVD risk factor assessment tools and CVD risk calculators do not account for these differences and systematically underestimate CVD risk in women.

Be Healthe for your Heart Study Protocol: Preventing cardiovascular disease among women with a history of pre-eclampsia

For women with a history of pre-eclampsia, the odds of cardiovascular disease (CVD) related morbidity later in life are doubled, and mortality almost tripled compared to other women. Clinical practice guidelines recommend that women with a history of pre-eclampsia have regular CVD risk factor assessment (e.g., blood pressure, serum lipids), and receive counselling about maintaining a healthy weight, healthy eating and adequate physical activity. However, there is currently a lack of health services or programs that address CVD prevention in this group. This project aims to address this gap by creating an eHealth intervention aimed at achieving a healthy lifestyle post pre-eclampsia for CVD prevention. This abstract describes the protocol for a feasibility study. In the 3-month randomised control trial, women, aged 18–45 years, with a recent (≤ 4 years) pregnancy complicated by pre-eclampsia will be randomly allocated to Be Healthe for your Heart or a control group. Be Healthe for your Heart supports participants to make changes to key lifestyle behaviours associated with CVD risk, using evidence-based behaviour change techniques (e.g. self-monitoring, goal setting). Be Healthefor your Heart program resources are tailored to women of childbearing age and delivered via website and email newsletters. Outcomes will be measured at baseline and 3-months, including 10-year cardiovascular risk score, CVD risk markers (BMI, waist circumference, blood pressure, plasma lipids), lifestyle risk factors (dietary intake, physical activity, stress) and general health and well-being. Intervention acceptability will be evaluated using objective usage data, and intervention participant feedback via a process evaluation questionnaire. This eHealth CVD prevention program aims to address the unmet needs of a high-risk group of women. Findings of the feasibility study will inform future efficacy trials, and translation of CVD prevention services for women with a history of pre-eclampsia.

Changes in Care After Implementing a Multifaceted Intervention to Improve Preventive Cardiology Practice in Rheumatoid Arthritis

Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) risk. However, CVD risk factor identification and treatment is often inadequate. The authors implemented a multifaceted rheumatology practice intervention to improve CVD risk factor measurement, assessment, and management. The intervention included clinician education, point-of-care decision support, feedback, and care management. The authors measured quality indicators from electronic health records and assessed impact with interrupted time series. Following the intervention, more RA patients had all major CVD risk factors assessed (53% vs 72.2%), and the rate of increase was greater during the intervention period than baseline (difference of 0.74% per month, P = .0016). Moderate- or high-intensity statin prescribing increased (21.6% to 28.2%), but the rate of change was not different from baseline. Several other quality measures did not increase. Although CVD risk factor assessment improved, the intervention did not affect risk factor management and control. Other strategies are needed to optimize CVD prevention in RA.

Gender impact on children's knowledge and perceptions regarding cardiovascular disease risk factors: A school-based survey in Greece.

BACKGROUND:Cardiovascular disease (CVD) risk factors are adopted during childhood and adolescence. Health literacy at these ages remains the cornerstone of a healthy adult life. The aim of the study was to examine the role of gender regarding CVD risk factors’ awareness and to develop an evaluation tool for the assessment of CVD risk factors’ knowledge and perception among children.METHODS:During the school years 2014–2015 and 2015–2016, 1728 students aged 10–12 years (5th and 6th grade), from 5 Greek cities (including Athens metropolitan area), were enrolled; nearly 45% were boys (participation rate varied from 95% to 100% from school to school). Students and their parents completed an anonymous questionnaire; students’ somatometric characteristics were also recorded. Schools were randomly selected. Linear regression models were applied to evaluate the impact of children's gender on knowledge and perceptions about CVD risk factors.RESULTS:Significant higher percentage of correct answers, among girls compared to boys, was revealed regarding the weekly consumption of legumes, the breakfast weekly consumption, and the effects of soft drinks on health (all P < 0.05). As far as CVD risk factors’ knowledge, significantly higher percentage of girls than boys also answered that high blood pressure and television viewing are bad for health and particularly for heart-related problems (all P < 0.05). Girls had a significantly higher mean score of 0.304 than boys, after adjusting for several confounders (P = 0.029).CONCLUSION:Health education programs should take into account gender differences in children's perception and attitudes toward CVD risk factors, in order to increase awareness of children and eventually reduce CVD risk during adulthood.

Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives.

Life expectancy in autoimmune rheumatic diseases (ARDs) remains lower compared to the general population, due to various comoborbidities. Cardiovascular disease (CVD) represents the main contributor to premature mortality. Conventional and biologic disease-modifying antirheumatic drugs (DMARDs) have considerably improved long-term outcomes in ARDs not only by suppressing systemic inflammation but also by lowering CVD burden. Regarding atherosclerotic disease prevention, EULAR has recommended tight disease control accompanied by regular assessment of traditional CVD risk factors and lifestyle changes. However, this approach, although rational and evidence-based, does not account for important issues such as myocardial inflammation and the long asymptomatic period that usually proceeds clinical manifestations of CVD disease in ARDs before or after the diagnosis of systemic disease. Cardiovascular magnetic resonance (CMR) can offer reliable, reproducible and operator independent information regarding myocardial inflammation, ischemia and fibrosis. Some studies suggest a role for CMR in the risk stratification of ARDs and demonstrate that oedema/fibrosis visualisation with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation. In this review, we discuss how CMR findings could influence anti-rheumatic treatment decisions targeting optimal control of both systemic and myocardial inflammation irrespective of clinical manifestations of cardiac disease. CMR can provide a different approach that is very promising for risk stratification and treatment modification; however, further studies are needed before the inclusion of CMR in the routine evaluation and treatment of patients with ARDs.

Adipokines, Inflammation, and Adiposity in Hematopoietic Cell Transplantation Survivors

Adult survivors of acute leukemia in childhood have a higher-than-expected frequency of obesity and are at increased risk for metabolic syndrome and early mortality from cardiovascular disease (CVD). Adipose tissue has been recognized as an endocrine and paracrine organ that secretes various adipokines involved in metabolic regulation and inflammatory processes. In this study, we examined inflammatory factors (IL-6 and TNF-α) and adipokines (adiponectin, leptin), in addition to body composition and adiposity, in cancer survivors who underwent hematopoietic cell transplantation (HCT) during childhood compared with sibling controls. Over 2-year survivors of HCT for hematologic malignancies during childhood were recruited from 2 institutions along with a control population of siblings. Participants underwent evaluation for body composition, anthropometric measurements, and assessment of CVD risk factors and adipokines. Cases were stratified by radiation exposure in the preparative regimen (total body irradiation [TBI] + central nervous system [CNS] irradiation, TBI only, chemotherapy only) and adjusted least squares means were estimated for each adipokine and adjusted by age, sex, race, Tanner stage, and percent fat mass (PFM) percentiles (0-24, 25-74, 75+). A total of 151 HCT survivors and 92 siblings underwent evaluation. Significant differences in mean adipokine levels were detected between survivors and siblings; leptin was significantly higher and adiponectin significantly lower in HCT survivors who received TBI with or without CNS irradiation compared with siblings. IL-6 was significantly higher in all groups of HCT survivors compared with siblings. Body mass index (BMI) was similar in survivors and controls, although PFM was significantly higher in all groups of HCT survivors and lean body mass (LBM) was lower in survivors who received TBI with or without CNS radiation compared with siblings. HCT survivors showed an unfavorable profile of inflammation, adipokines, and adiposity, despite similar BMI as controls. Higher PFM and lower LBM may contribute to these findings. TBI exposure is correlated with greater severity of these observations. Increasing LBM may represent a tangible target for mitigating the high cardiometabolic risks of HCT survivors.

Neck circumference and clustered cardiovascular risk factors in children and adolescents: cross-sectional study

ObjectiveEarly detection of cardiovascular disease (CVD) risk factors, such as obesity, is crucial to prevent adverse long-term effects on individuals’ health. Therefore, the aims were: (1) to explore the robustness...

Gender inequalities in cardiovascular risk factor assessment and management in primary healthcare

ObjectivesTo quantify contemporary differences in cardiovascular disease (CVD) risk factor assessment and management between women and men in Australian primary healthcare services.MethodsRecords of routinely attending patients were sampled from 60...

Depression and Progression of Subclinical Cardiovascular Disease in Systemic Lupus Erythematosus.

Women with systemic lupus erythematosus (SLE) have an increased incidence of premature cardiovascular disease (CVD). A relationship between depression and increased inflammation leading to CVD has been proposed. The aim of this study was to evaluate the relationship between depression and the progression of subclinical atherosclerosis in women with SLE. In this prospective case-control study, 149 participants with SLE and 126 controls were followed over 5 years. Evaluation included laboratory studies, assessment of CVD risk factors, depression screening, ultrasound evaluations of carotid intima-media thickness (CIMT) and carotid plaque, and assessment of SLE disease activity for the SLE cases. The SLE group had a higher rate of depression: 29% compared with 11% in the control group (P = 0.003). When controlling for traditional CVD risk factors, the presence of baseline depression correlated with increased progression of CIMT in the SLE group, but not in the control group. The mean increase in CIMT was 0.026 mm in the SLE group without depression versus 0.064 mm in the depressed SLE group (P = 0.0096). There was no association between depression and carotid plaque in either group, with a calculated odds ratio for plaque progression in the depressed SLE group of 1.118 (95% confidence interval 0.476, 2.623) in the adjusted model. Women with SLE and concomitant depression have an increased risk of developing subclinical atherosclerosis, as measured by CIMT, but not by carotid plaque. The data suggest that depression, a potentially modifiable risk factor, may contribute to the increased risk of subclinical atherosclerosis in women with SLE.

Measurement of overweight and obesity an urban slum setting in sub-Saharan Africa: a comparison of four anthropometric indices.

BackgroundAs a result of both genetic and environmental factors, the body composition and topography of African populations are presumed to be different from western populations. Accordingly, globally accepted anthropometric markers may perform differently in African populations. In the era of rapid emergence of cardio-vascular diseases in sub-Saharan Africa, evidence about the performance of these markers in African settings is essential. The aim of this study was to investigate the inter-relationships among the four main anthropometric indices in measuring overweight and obesity in an urban poor African setting.MethodsData from a cardiovascular disease risk factor assessment study in urban slums of Nairobi were analyzed. In the major study, data were collected from 5190 study participants. We considered four anthropometric markers of overweight and obesity: Body Mass Index, Waist Circumference, Waist to Hip Ratio, and Waist to Height Ratio. Pairwise correlations and kappa statistics were used to assess the relationship and agreement among these markers, respectively. Discordances between the indices were also analyzed.ResultsThe weighted prevalence of above normal body composition was 21.6 % by body mass index, 28.9 % by waist circumference, 45.5 % by waist to hip ratio, and 38.9 % by waist to height ratio. The overall inter-index correlation was +0.44. Waist to hip ratio generally had lower correlation with the other anthropometric indices. High level of discordance exists between body mass index and waist to hip ratio. Combining the four indices shows that 791 (16.1 %) respondents had above normal body composition in all four indices. Waist circumference better predicted hypertension and hyperglycemia while waist to height ratio better predicted hypercholesterolemia.ConclusionsThere exists a moderate level of correlation and a remarkable level of discordance among the four anthropometric indices with regard to the ascertainment of abnormal body composition in an urban slum setting in Africa. Waist circumference is a better predictor of cardio-metabolic risk.

Canadian Hypertension Education Program Recommends the Use of Nonfasting Lipid Panels for Routine Laboratory Workup

Hypertension is a well-established risk factor for cardiovascular disease (CVD).2 Assessment of lipids, physical activity, alcohol consumption, and other CVD risk factors in this patient population is an essential component of disease management. The use of nonfasting samples for lipid panels has been a matter of ongoing debate. In 2009, Denmark was the first to use nonfasting lipid panels for routine testing based on recommendations from the Danish Society for Clinical Biochemistry. Although the 2013 American College of Cardiology/American Heart Association guidelines preferred fasting samples for routine lipid panels, the choice of specimen type was left to the clinician's discretion. Recently, the European Atherosclerosis Society (EAS) and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) made a strong …

Spiral artery remodeling and maternal cardiovascular risk: the spiral artery remodeling (SPAR) study.

Women with a history of placental bed disorders, including preeclampsia and intrauterine growth restriction have an increased long-term risk of cardiovascular disease (CVD). Further, similarities exist between atherosclerosis and abnormalities observed in placental bed spiral arteries in pregnancies affected by preeclampsia and intrauterine growth restriction, such as acute atherosis and defective remodeling. This suggests a common pathophysiological pathway underlying both disorders. The aim of this study was to investigate vascular and inflammatory lesions in the placental bed of women with preeclampsia and normal pregnancy using a systematic approach to characterize lesions of the placental bed, and relate spiral artery pathology to postpartum CVD risk assessment. Placental bed punch biopsies were performed following caesarean section and systematically studied to assess vascular pathology, arterial remodeling, and the presence of CD3, CD56, and CD68 cells. In addition, levels of modifiable CVD risk factors were assessed immediately postpartum. We found fewer spiral arteries with complete remodeling in women with preeclampsia than in the control group (21 vs. 68%; P = 0.008). Further, women with preeclampsia showed less presence of CD3 cells in both the decidua and the myometrium. Preliminary findings of CVD risk factor assessment postpartum suggest a correlation between acute atherosis and higher triglyceride and low-density lipoprotein cholesterol levels. Systematic study of vascular pathology in uterine spiral artery biopsy samples in relation to CVD risk factors provides valuable insight into the link between cardiovascular health and placental bed disorders.