Risk Factor For Various Cardiovascular Diseases Research Articles

The Value of Four Anthropometric Indicators for Identifying Left Ventricular Hypertrophy in Chinese Hypertensive Patients.

Left ventricular hypertrophy (LVH) has been classified separately as an independent risk factor for hypertension. However, comparisons between different body size indices and left ventricular hypertrophy (LVH) in hypertensive populations have not been reported yet. In this study, we enrolled 4,639 hypertensive patients from rural China. Anthropometric indices and cardiovascular disease risk factor variables were measured and analyzed using Spearman's correlation, logistic regression, and receiver operating characteristic (ROC) curve analyses. Patients in the highest quartile of body size indices were more likely to have left ventricular hypertrophy than those in the lowest quartile; these indices were BMI (adjusted OR: 3.55, 95% CI: 2.90; 4.35), WC (adjusted OR: 2.23, 95% CI: 1.84; 2.70), WHR (adjusted OR: 1.44, 95% CI: 1.18; 1.75), and WHtR (adjusted OR: 3.23, 95% CI: 2.62; 3.99). The areas under the ROC curves of BMI (AUC: 0.628, 95% CI: 0.612; 0.644), WHtR (AUC: 0.628, 95% CI: 0.560; 0.593), WHR (AUC: 0.530, 95% CI: 0.513; 0.547), and WC (AUC: 0.576, 95% CI: 0.513; 0.547) were all above 0.5, which indicated that the four anthropometric indicators may be associated with LVH. The four anthropometric indicators of obesity were identified as risk factors for LVH. Weight control might help reduce the risk of left ventricular hypertrophy.

A Comparative Angiographic Severity of Coronary Artery Disease in Diabetic and Non Diabetics in a Tertiary Cardiac Centre

Introduction: Diabetes is a major risk factor for various cardiovascular diseases including coronary artery disease. Coronary atherosclerosis is not only more prevalent in diabetic patients but is also more severe. Diabetics are more prone to multi vessel involvement as well as associated with poor outcomes to acute coronary events. Methods: This is a hospital based descriptive cross-sectional study including 300 patients (diabetic and non-diabetic) undergoing coronary angiography at Sahid Gangalal National Heart Centre over a period of one year (January to December 2016). Results: Out of the total 300 patients studied at angiography, majority (68.3%, 205 patients) were male with the age group ranging from 29 to 86 years of age. Significant number of diabetics had associated risk factor as hypertension (88%) as the most common. Brahmins and Madhesi (27% each) ethnic group of origin formed the major group studied. Significant coronary artery disease defined as >50 % stenosis was evident in 118 patients (78.7%) among diabetics whereas it was present in 99 patients (66%, p value 0.01, significant). Maximum number of diabetic patients had presence of triple vessel disease ( 52 patients, 34.7 %) followed by double vessel and single vessel disease ( 25.3 % and 18.7 %) respectively as well as more number of diffuse vessel disease (28 % ,p value 0.006 ) . The mean Gensini score studied was 33.07±28.7 with the highest Gensini score of 126. Diabetic group of patients had a higher Gensini scores (37.2 ± 28.4) as compared to non-diabetic (28.9 ± 28.6, p value <0.05). Conclusion: Diabetic patients had higher total Gensini scores at angiogram which reflect greater severity of coronary artery disease as compared to non-diabetics as well as higher incidence of triple vessel disease and diffuse coronary artery disease.

Abstract P3010: Longitudinal Associations of Risk Factors for Cardiovascular Disease With the Progressions of Arterial Stiffness and Pressure Wave Reflection, and Their Independencies in Healthy Men

Background: Arterial stiffness and abnormal pressure wave reflection have been demonstrated as independent risks for future cardiovascular outcomes. While cross-sectional studies have been reported that some of risk factors for cardiovascular disease (CVD) are associated with arterial stiffness and also with pressure wave reflection, further studies are needed to clarify whether these risk factors affect the progression of arterial stiffness and that of abnormal pressure wave reflection. Aims: The present prospective observational study was conducted to examine the longitudinal associations of risk factors for CVD with the progression of arterial stiffness and abnormal pressure wave reflection, and the differences among the those associations. Methods and Results: In 4016 middle-aged (43±9 years) Japanese men without CVD at the study baseline, risk factors for CVD, brachial-ankle pulse wave velocity (baPWV), and radial augmentation index (rAI) were measured annually during a 9-year study period. Mix model linear regression analyses demonstrated that age and mean blood pressure had significant independent longitudinal associations with both baPWV and rAI. Heart rate had a significant positive association with baPWV and had an inverse association with rAI. However, glyco-hemoglobrin A1c (estimate = 25.21, standard error = 5.89, P &lt;0.01) and triglycerides (estimate = 0.19, standard error = 0.05, P &lt;0.01) had a longitudinal association only with baPWV. Conclusion: Various risk factors for CVD may differently affect the progression of arterial stiffness and also abnormal pressure wave reflection. Hypertension may affect both progressions individually apart from their interactions, and therefore, hypertension may affect both macro- and micro- circulations. On the other hand, abnormal glucose metabolisms and dyslipidemia may affect arterial stiffness rather than pressure wave reflection, which means these abnormal metabolisms may affect only macro-circulation. Thus, these heterogeneities of associations of risk factors for cardiovascular disease with arterial stiffness and pressure wave reflection may be needed to be taken into account for the management of their abnormalities.

The role of the kynurenine pathway of tryptophan metabolism in cardiovascular disease. An emerging field.

Coronary heart disease and stroke, the deadliest forms of cardiovascular disease (CVD), are mainly caused by atherosclerosis, a chronic inflammatory disease of the artery wall driven by maladaptive immune responses in the vessel wall. Various risk factors for CVD influence this pathogenic process, including diabetes mellitus, hypertension, dyslipidaemia, and obesity. Indoleamine 2,3-dioxygenase (IDO), an enzyme catalyzing the rate-limiting step in the kynurenine pathway of tryptophan degradation, is strongly induced by inflammation in several tissues, including the artery wall. An increasing body of evidence indicates that IDO promotes immune tolerance, decreases inflammation, and functions as a homeostatic mechanism against excessive immune reactions. This review provides an overview of the emerging field of the kynurenine pathway of tryptophan degradation in CVD, emphasizing the role of IDO-mediated tryptophan metabolism and its metabolites in the modulation of 'classical' cardiovascular risk factors, such as hypertension, obesity, lipid metabolism, diabetes mellitus, and in the development of atherosclerotic CVD.

Plasma homocysteine is adversely associated with glomerular filtration rate in asymptomatic black and white young adults: the Bogalusa heart study

That plasma homocysteine is elevated markedly in renal dysfunction is well recognized. But whether the increased homocysteine is an independent correlate of glomerular filtration rate, a marker of renal function, in asymptomatic younger individuals is not clear. The aim of this study was to determine the association between plasma homocysteine and renal function in a biracial (black-white) community-based cohort of asymptomatic young adults. Plasma homocysteine along with cardiovascular disease risk factor variables were measured in 805 white and 330 black subjects, ages 24-44 years, enrolled in the Bogalusa Heart Study. Modification of Diet in Renal Disease Study equation was used to calculate the estimated glomerular filtration rate (eGFR) from serum creatinine level. Males versus females showed higher homocysteine levels (8.83 +/- 3.16 vs. 7.35 +/- 2.84 micromol/L, p < 0.0001) and lower eGFR (99.1 +/- 17.6 vs. 102.5 +/- 21.0 mL/min/1.73 m(2), p = 0.024). Whites versus blacks had lower eGFR (97.3 +/- 18.0 vs. 110.0 +/- 20.6 mL/min/1.73 m(2), p < 0.0001). In a multivariate regression analysis that included age, race, sex, body mass index, blood pressure, lipoprotein variables, insulin resistance index and homocysteine, white race, age and homocysteine, in that order, were independently and negatively associated with eGFR. The odds ratio (95% confidence interval) of individuals in the homocysteine quintiles II, III, IV and V vs. I for having the risk of impaired eGFR defined as <10th percentile was 2.28 (0.95-5.50, p = 0.065), 2.97 (1.24-7.12, p = 0.015), 3.32 (1.45-7.60, p = 0.005) and 6.99 (3.06-15.94, p < 0.0001), respectively. Homocysteine is an independent correlate of renal function in asymptomatic black and white young adults.

Relation of Plasma Homocysteine to Arterial Stiffness in Black and White Young Adults (from the Bogalusa Heart Study)

The aim of this study was to determine the association between homocysteine and arterial wall stiffness in a biracial (black and white) community-based cohort of asymptomatic young adults. That increased plasma homocysteine was adversely associated with atherothrombosis was well recognized. However, findings about the association of homocysteine and arterial wall stiffness, an indicator of vascular damage, were conflicting. Plasma homocysteine and other cardiovascular disease risk-factor variables were measured in 735 white and 294 black subjects aged 24 to 44 years enrolled in the Bogalusa Heart Study. Large-artery stiffness was assessed in terms of aorta-femoral pulse wave velocity (af-PWV) using echocardiography Doppler. Men versus women had higher fasting homocysteine (8.85 vs 7.32 micromol/L; p <0.01), and blacks versus whites had higher af-PWV (5.47 vs 5.24 m/s; p <0.01). In bivariate analyses, log-transformed homocysteine significantly correlated with af-PWV (p = 0.0004). In multivariate stepwise regression analyses, systolic blood pressure, age, heart rate, log-homocysteine, log-Homeostasis Model Assessment of Insulin Resistance, and smoking, in that order, were independently and positively associated with af-PWV. In conclusion, plasma homocysteine was an independent correlate of arterial stiffness in asymptomatic black and white young adults and may be a potential marker for cardiovascular disease risk in this age group.

The Emergence of Clinically Abnormal Levels of Cardiovascular Disease Risk Factor Variables Among Young Adults: The Bogalusa Heart-Study

Background. The Bogalusa Heart Study, a long-term epidemiologic investigation of the early natural history of atherosclerosis, was conducted for the first time in 1973-1974 on children from birth through the age of 14 in a biracial (black-white) population. Methods. The emergence of clinically recognizable abnormalities (obesity, hypertension, and hyperlipidemia) was studied in 1,928 young adults, ages 19-32 years, examined in the 1988-1991 survey. Results. The occurrence of morbid levels of cardiovascular disease risk factors varied by race and gender. The prevalence of severe overweight, body mass index ≥ 31.1 kg/m2 for males and ≥ 32.3 kg/m2 for females, was much higher for black women (20.1%) than for white women (8.7%), black men (14.0%), or white men (11.7%). The frequency of hypertension [systolic blood pressure (BP) ≥ 140 mm Hg, diastolic BP ≥ 90 mm Hg, or treatment for high BP] was greatest for black women (13.9%) versus black men (10.1%), white men (6.2%), or white women (5.0%). Approximately 9.5% of the men and 6% of the women had elevated LDL cholesterol (≥160 mg/dl), while elevated triglycerides (≥250 mg/dl) ranged from 0% in black females to 7.4% in white males. Dyslipoproteinemia related to HDL cholesterol (≤35 mg/dl) was more marked among white men (16%) compared with the other groups (approximately 4%). Correlations for risk factors in a subgroup of 1,587 individuals initially surveyed as children in 1973-1974 were examined as an indication of tracking over a 15-year period. Highly significant correlations were seen for obesity, blood pressure, and LDL cholesterol. Conclusion. Early identification of adverse levels of cardiovascular disease risk factors defined by clinical experience should help to predict and prevent future cardiovascular disease morbidity and mortality.

Measurement error and reliability in four pediatric cross-sectional surveys of cardiovascular disease risk factor variables—The Bogalusa Heart Study

Four cross-sectional epidemiologic studies of children 5–17 years of age were conducted between 1973 and 1982 in the community of Bogalusa, La. Anthropometric, blood pressure and serum lipid variables were measured. Measurement error (precision) and reliability (reproducibility) were estimated for these risk factor variables of coronary artery disease. Precision was less than 0.8 cm for height, 0.8 kg for weight, and 1 mm for triceps and subscapular skinfold over the four surveys. Measurement error for the mercury sphygmomanometer and automatic blood pressure instruments was between 4 and 5 mmHg during this same period. Except for triglycerides and total and α-lipoprotein cholesterols that stabilized at lower levels after the first survey, precision of laboratory variables remained nearly constant over the 9 years of survey. Anthropometric measurements were found to be the most reliable followed next by the laboratory and then blood pressure measurements. These estimates offer guidelines applicable to data collection and processing in future investigations of risk factor variables for coronary artery disease.

Cardiovascular Risk Factors and Their Modification in Children

Normal levels and trends of cardiovascular disease risk factors in childhood have been well documented by numerous epidemiologic surveys. Expected levels of blood pressure, lipids and lipoproteins, and body size can be determined by the child's physician using race- and gender-specific grids. These grids allow for the identification and follow-up of children with high-risk profiles. Evidence of increased left ventricular mass and vascular changes in renal arteries in association with childhood blood pressure level along with atherosclerotic fatty streak and fibrous plaque development in the aorta and coronary arteries shows that children with elevated risk factors are at risk for early target organ damage. These data demonstrate the potential importance of early intervention on the natural history of cardiovascular disease. Based on our own data from the Bogalusa population, as well as evidence from other epidemiologic investigations in children, the following recommendations can be made, regardless of the risk factor variable under consideration: Cardiovascular disease risk factor variables should be measured carefully and in a serial manner to classify a child as abnormal. Serial measurements serve to reduce the effect of regression to the mean and increase the predictive value of the measurements. The misclassification of normal children into the high-risk category can be avoided by serial and replicate observations. Interventions that have attendant side effects (for example, pharmacologic therapy for high blood pressure) have to be measured against the effectiveness of diet, exercise, and other aspects of primary prevention. Risk factor levels consistently greater than the ninetieth percentile deserve medical attention. Care should be taken prior to using specific grids of normal levels of cardiovascular disease risk factors in children. The measurement techniques employed on individuals should be similar to those used by the epidemiologic study to generate the grids in a reference population. The grids should become part of the child's permanent medical record, as they provide a rapid visual assessment of the cardiovascular disease risk profile over time. High-risk trackers may require more intensive follow-up and will allow for early intervention and an assessment of the efficacy of the intervention program. In conclusion, cardiovascular disease risk factor screening in childhood is quick, effective, and inexpensive. The potential payoff in prevention of adult cardiovascular disease is enormous and allows the physician to provide more comprehensive care to a pediatric population.

Tracking of cardiovascular disease risk factor variables in school-age children

Persistence in ranks (tracking) for cardiovascular disease risk factor variables was examined in 2236 children who were screened three times over a 5-yr period. As expected, the greatest persistence was noted for height ( r = 0.47–0.99) and weight ( r = 0.70–0.96). Correlation coefficients for systolic blood pressure and diastolic blood pressure ranged from 0.38 to 0.66 and 0.22 to 0.49 respectively. Among lipids, the correlations were highest for serum β-lipoprotein cholesterol ranging from 0.62 to 0.78. For those children who were at or above the 90th percentile on a risk factor variable during the first examination, a tendency to retain their ranks in the second and third examinations was noted. For systolic blood pressure, 35% of those initially high remained high in the second examination and 30% in the third examination. Correspondingly, for those initially high for β-lipoprotein cholesterol, 47 and 41% remained high. A linear discriminant model was used to distinguish characteristics of children who persisted at high rankings and those who did not. The model was effective for total and β-lipoprotein cholesterol, but only moderately so for systolic blood pressure.

Parental history and cardiovascular disease risk factor variables in children

As part of a total community study of cardiovascular disease (CVD) risk factor variables in children (ages 5–17 years), parental histories of heart attacks, hypertension, diabetes, and stroke were obtained for each of 4,074 participating children. Subsequently, each child was examined for serum total cholesterol, triglycerides, lipoproteins (LP) and glucose, measurement of height, weight, triceps skinfold thickness, and blood pressure (BP), and had a physical examination. A family history of high BP was reported by 26.5% of all children, diabetes by 7.1%, heart attacks by 6.8%, and stroke by 2.1%. The children of parents with heart attacks or diabetes were heavier and had different lipid and LP profiles than children without this background. Children of reported hypertensive parents had higher systolic and diastolic BP, were heavier and had thicker skinfolds. The heaviest children were more likely to have a parental history of diabetes, hypertension, and heart attack. Children in the highest decile for systolic or diastolic BP were more likely to come from a family reporting hypertension. Children with the highest cholesterol, triglycerides, β + pre-β-LP and lowest α-LP values tended to have parents with heart attacks or diabetes. These data indicate that familial tendencies in multiple CVD risk factors are observable early in life. Children of parents with CVD or manifested risk factors clearly differ in their own risk factor profiles from children of parents without these conditions.

Cigarette smoking and tobacco usage behavior in children and adolescents: Bogalusa heart study

As part of a comprehensive program to assess cardiovascular disease risk factor variables in an entire biracial pediatric population, a study of cigarette smoking was included in the Bogalusa Heart Study. The purpose of the study was to obtain reliable and valid data on attitudes, beliefs, and cigarette-smoking behavior. The questionnaire demonstrates good internal consistency, test-retest reliability, and external validation with plasma thiocyanate. For all sex and race groups the percentage of smokers increases with age. White boys begin smoking exposure and adopt cigarette smoking earlier (32% of 14- to 15-year-olds) while white girls increase and surpass the boys by ages 16 to 17 (41%). Black boys and girls lag behind white children in early experience and adoption of smoking behavior. The largest percentage of experimental nonadopters (those who said they tried cigarettes to see what they were like but do not smoke now) occurs among the 12- to 13-year-olds for each race-sex group except black girls.

Persistence of levels for risk factor variables during the first year of life: The Bogalusa Heart Study

The changes in cardiovascular disease risk factor variables during the first year of life were studied in a cohort of 440 children in Bogalusa, Louisiana. Statistically significant correlations were most evident for risk factor variable levels between 6 months and 1 yr of age with correlation coefficients of 0.81 for length, 0.87 for weight, 0.28 for systolic blood pressure, 0.42 for serum total cholesterol and 0.53 for β-lipoprotein cholesterol (all p < 0.0001). In a multiple-regression analysis in which the value of the risk factor variable at 1 yr of age is the dependent variable, only the value of that variable at 6 months of age yielded regression coefficients that were consistently statistically significant. For those children who were in the upper or lower deciles for a risk factor variable at 6 months of age, the distributions at 1 yr of age indicated a persistence in ranks. Some 32% of those in the top decile at 6 months for systolic blood pressure were also in the top decile at 1 yr of age. Similarly 30% of those in the top decile for serum total cholesterol, and 40% for β-lipoprotein cholesterol, remained at 1 yr in the top decile for total and β-lipoprotein cholesterol, respectively. Tracking can be detected in infants even with the dramatic changes occurring during the first year of life. These considerations are important for the study of the early natural history of coronary artery disease and hypertension and may help us to determine the earliest age for prediction of those children who will be prone to have heart disease as adults.

Cardiovascular disease risk factor variables during the first year of life.

Cardiovascular risk factor variables were measured in a cohort of 440 infants at birth 6 months, and 1 year of age. Blood pressures at 6 months of age were 93/47 mm Hg (systolic/diastolic pressure, fourth phase) and 97/51 mm Hg at 1 year of age. Serum total cholesterol, beta-lipoprotein, and alpha-lipoprotein levels rose dramatically from birth to 1 year of age. Serum triglycerides also showed an increase from birth to 6 months of age, but a decrease from 6 months to 1 years of age. At 6 months of age, the infants were consuming 949 kcal and at 1 year, 1,356 kcal. A statistically significant correlation between serum cholesterol level and protein, fat, cholesterol, and carbohydrate intake was noted at 1 year of age. These observations provide a background for tracing the evolution of risk factor variables as part of the early natural history of arteriosclerosis.

Cardiovascular disease risk factor variables in children at two successive years—the Bogalusa heart study

As part of a community study of cardiovascular disease risk factor variables, 1101 children in four age-cohorts (5, 8, 11, 14 years) were examined during two successive years. The bivariate correlations within each of the four cohorts between one year and the next were highest for height, weight and triceps skinfold, intermediate for systolic blood pressure, total cholesterol, and β-lipoprotein, and lowest for diastolic blood pressure, triglycerides, pre-β-lipoprotein, and α-lipoprotein. Employing multiple linear regression, we observed that once the level of a specified risk factor variable at the time of the initial examination was known, the inclusion of six additional independent variables did not substantially increase our ability to predict the level of that specific risk factor variable one year later. In a further analysis of the extremes, we observed that of those children who had triceps skinfold thicknesses above the 90th percentile at the first examination, over 70% remained in the top decile one year later. Comparable findings for blood pressure were 41% for systolic and 23% for diastolic, while for the lipids and lipoproteins, between 45 and 32% of those with initially elevated levels remained above the 90th percentile. These results suggest that tracking of obesity, blood pressure, and serum lipids and lipoproteins which is known to occur during adulthood is apparent, on an annual basis, in 5-to 15-year-old pediatric age groups.

BLOOD PRESSURE OF CHILDREN, AGES 2½–5½ YEARS, IN A TOTAL COMMUNITY—THE BOGALUSA HEART STUDY

Eighty per cent of all identified children 2 1/2-5 1/2 years old in a total geographic community in Bogalusa, Louisiana, were examined for cardiovascular disease risk factor variables, including blood pressure (BP), anthropometric measurements, and blood lipids. Blood pressure was measured by three instrument types, each with three readings, according to a rigid, randomized design. Results from the three instruments were compared, and potential biases for each instrument are listed. All observations on the children were analyzed by multiple regression with BP as the dependent variable. After controlling for the mood of the child, the authors found that some index of body size was positively related to BP, whereas age, race, and serum lipids were not consistently related. The regressions of blood pressure on height as well as on log weight fit straight lines. These results conform with the findings for the 5- to 14-year-olds in this community. The basal or fundamental reference blood pressure is likely to rise gradually from birth to the age of incipient adult stature, and to be linearly related to height and to log weight. Changes observed over time are needed to relate BP levels in childhood to the early natural history of essential hypertension.

Cardiovascular disease risk factor variables at the preschool age. The Bogalusa heart study.

Cardiovascular disease risk factor variables at the preschool age. The Bogalusa heart study.

Dietary studies and the relationship of diet to cardiovascular disease risk factor variables in 10-year-old children — The Bogalusa Heart Study ,

A dietary study of 10-year-old children was incorporated into a larger epidemiological survey investigating the distributions, interrelationships, and course-over-time of arteriosclerosis risk factor variables in children. Food intakes, eating patterns, and diet-risk factor interrelationships are described for 185 children (35% black, 65% white) using an improved 24-hr dietary recall method. Protein intakes were high. The polyunsaturated-to-saturated fatty acid ratio averaged 0.4 and a sucrose-to-starch proportion of 1.1 was noted. Eggs were the main food source of cholesterol and milk was the prime source of saturated fatty acids and protein. Black girls had a significantly greater mean sodium intake than the three other sex-race groups. Intermittent snacks provided the most calories; breakfast and dinner contributed most of the day's cholesterol, and lunch was the prime source of lactose and calcium. Longer eating spans reflected significantly greater intakes of calories, protein, fat, carbohydrate, and sodium, and greater levels of total serum cholesterol. A lack of correlation was noted in large matrices of dietary components and risk factor variables, but results of the comparison of mean intakes of dietary components for children grouped according to serum cholesterol showed significant differences in the intakes of various forms of fat and carbohydrate.