Cardiovascular Disease Risk Factors In Women Research Articles

Changes of Serum Angiotensin Peptides, Pro-Endothelin-1 Levels in Women One Year After Preeclampsia and their Association with Cardiovascular Risk Factors

Abstract Introduction Women who suffered preeclampsia (PE) have two to four times higher risk for development of cardiovascular disease (CVD) compared with women with a history of normotensive pregnancy. Microvascular and endothelial dysfunction, mediated by different vasoactive factors have been suggested as attainable pathophysiological pathways. The study aimed to: (1) determine changes in circulating levels of key vasoactive peptides in sera of women with history of PE and in women who had a normal pregnancy 1 year after delivery and (2) investigate whether an association exists between these molecules and cardiovascular risk factors. Materials and methods The current research examined 32 women one year after preeclampsia (mean age 25.3 ± 6.3 years) and control group of 20 women one year after normal pregnancy (mean age 25.6 ± 5.6 years). The enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of angiotensin II (AngII), angiotensin-(1-7) [Ang-(1-7)] and pro-endothelin-1 (Pro-ET-1). Results We found that at 1 year after delivery 38.46% of women who suffered PE have developed hypertension and 5.77% have developed diabetes mellitus. Women who had normal pregnancy developed neither hypertension, nor diabetes mellitus 1 year after delivery. Serum AngII levels in women one year after PE were statistically significantly lower than in women one year after normotensive pregnancy 0.9 (0.55÷1.7) vs. 2.3 pg/ml (2.0 ÷ 2.9) (KW = 20.849; p = 0.0001). Ang-(1-7) concentrations in women one year after PE were lower than in women one year after normal pregnancy, but not significantly 1.7 (0.3÷4.5) vs. 3.2 ng/ml (0.2÷8.0) (p>0.05). Levels of serum Pro-ET-1 in women one year after PE were statistically significantly higher than in women one year after normal pregnancy 322.65 (261.75÷391.85) vs. 248.7 pmol/L (231.05÷282.15) (KW = 6.639; p = 0.009). AngII showed correlation with AH grade (r = -0.33; 0.02), Ang-(1-7) (r = 0.27; 0.05), DBP (r = -0.28; p = 0.04), mean arterial pressure (r = -0.43; p = 0.002), pulse pressure (r = -0.28; p = 0.04), BMI (r = -0.30; p = 0.03), TC (r = -0.31; p = 0.03) and LDL (r = -0.30; p = 0.03). Pro-ET-1 correlated with age (r = 0.30; p = 0.03), mean arterial pressure (r = -0.25; p = 0.05) and pulse pressure (r = 0.41; p = 0.003). Conclusion Our data showed an association between key vasoactive peptides and major CVD risk factors in women one year after PE. We suggest that imbalance between AngII, Ang-(1-7) and Pro-ET-1 could have a potential imply on the vascular wall after PE, reflecting persistent microvascular and endothelial injury/dysfunction postpartum. Further studies are warranted to clarify these vasoactive peptides’ role in the ongoing vascular endothelial function after delivery and the pathogenic mechanisms determining development of CVD in previously PE women.

Modifiable Risk Factors for Cardiovascular Disease among Women with and without a History of Hypertensive Disorders of Pregnancy.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women. Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies worldwide, and are an independent risk factor for CVD. A greater understanding of the rates of modifiable CVD risk factors in women with a history of HDP can inform CVD prevention priorities in this group. The aim of this study was to understand the rates of individual and multiple modifiable risk factors for CVD (body mass index, fruit and vegetable intake, physical activity, sitting time, smoking, alcohol consumption and depressive symptoms) among women with a history of HDP, and assess whether they differ to women without a history of HDP. This study is a cross-sectional analysis of self-reported data collected for the Australian Longitudinal Study of Women's Health (ALSWH). The sample included 5820 women aged 32-37 years old, who completed survey 7 of the ALSWH in 2015. Women with a history of HDP had a higher multiple CVD modifiable risk factor score compared to those without HDP (mean (SD): 2.3 (1.4) vs. 2.0 (1.3); p < 0.01). HDP history was significantly associated with a higher body mass index (p < 0.01), high-risk alcohol consumption (p = 0.04) and more depressive symptoms (p < 0.01). Understanding that women with a history of HDP have higher CVD risk factors, specifically body mass index, alcohol consumption and depressive symptoms, allows clinicians to provide appropriate and tailored CVD interventions for this group of women.

Cardiometabolic Risk Factors and Incident Cardiovascular Disease Events in Women vs Men With Type 1 Diabetes

The lower risk of cardiovascular disease (CVD) among women compared with men in the general population may be diminished among those with diabetes. To evaluate cardiometabolic risk factors and their management in association with CVD events in women vs men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. This cohort study used data obtained during the combined DCCT (randomized clinical trial, conducted 1983-1993) and EDIC (observational study, conducted 1994 to present) studies through April 30, 2018 (mean [SD] follow-up, 28.8 [5.8] years), at 27 clinical centers in the US and Canada. Data analyses were performed between July 2021 and April 2022. During the DCCT phase, patients were randomized to intensive vs conventional diabetes therapy. Cardiometabolic risk factors and CVD events were assessed via detailed medical history and focused physical examinations. Blood and urine samples were assayed centrally. CVD events were adjudicated by a review committee. Linear mixed models and Cox proportional hazards models evaluated sex differences in cardiometabolic risk factors and CVD risk over follow-up. A total of 1441 participants with type 1 diabetes (mean [SD] age at DCCT baseline, 26.8 [7.1] years; 761 [52.8%] men; 1390 [96.5%] non-Hispanic White) were included. Over the duration of the study, compared with men, women had significantly lower body mass index (BMI, calculated as weight in kilograms divided by height in meters squared; β = -0.43 [SE, 0.16]; P = .006), waist circumference (β = -10.56 cm [SE, 0.52 cm]; P < .001), blood pressure (systolic: β = -5.77 mm Hg [SE, 0.35 mm Hg]; P < .001; diastolic: β = -3.23 mm Hg [SE, 0.26 mm Hg]; P < .001), and triglyceride levels (β = -10.10 mg/dL [SE, 1.98 mg/dL]; P < .001); higher HDL cholesterol levels (β = 9.36 mg/dL [SE, 0.57 mg/dL]; P < .001); and similar LDL cholesterol levels (β = -0.76 mg/dL [SE, 1.22 mg/dL]; P = .53). Women, compared with men, achieved recommended targets more frequently for blood pressure (ie, <130/80 mm Hg: 90.0% vs 77.4%; P < .001) and triglycerides (ie, <150 mg/dL: 97.3% vs 90.5%; P < .001). However, sex-specific HDL cholesterol targets (ie, ≥50 mg/dL for women, ≥40 mg/dL for men) were achieved less often (74.3% vs 86.6%; P < .001) and cardioprotective medications were used less frequently in women than men (ie, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker: 29.6% [95% CI, 25.7%-33.9%] vs 40.0% [95% CI, 36.1%-44.0%]; P = .001; lipid-lowering medication: 25.3% [95% CI, 22.1%-28.7%] vs 39.6% [95% CI, 36.1%-43.2%]; P < .001). Women also had significantly higher pulse rates (mean [SD], 75.2 [6.8] beats per minute vs 71.8 [6.9] beats per minute; P < .001) and hemoglobin A1c levels (mean [SD], 8.3% [1.0%] vs 8.1% [1.0%]; P = .01) and achieved targets for tighter glycemic control less often than men (ie, hemoglobin A1c <7%: 11.2% [95% CI, 9.3%-13.3%] vs 14.0% [95% CI, 12.0%-16.3%]; P = .03). These findings suggest that despite a more favorable cardiometabolic risk factor profile, women with type 1 diabetes did not have a significantly lower CVD event burden than men, suggesting a greater clinical impact of cardiometabolic risk factors in women vs men with diabetes. These findings call for conscientious optimization of the control of CVD risk factors in women with type 1 diabetes.

Associations of plant-based dietary patterns with cardiovascular risk factors in women.

Introduction: Given that some plant-based foods, such as potatoes, adversely affect cardiovascular disease (CVD) risk factors, this study was performed to assess the association between plant dietary patterns and these risk factors. Methods: This cross-sectional study was conducted among 371 healthy 18 to 50 year-old Iranian women. Participant dietary intake was assessed using a validated food frequency questionnaire. Nineteen food groups were ranked in deciles and received scores from 1 to 10. An overall plant-based dietary index (PDI), a healthy plant-based dietary index (hPDI), and an unhealthy plant-based dietary index (uPDI) were calculated. Results: Participants who scored in the top tertile of the PDI or uPDI consumed less fat and protein and more carbohydrates, compared to women in the lowest tertile (P < 0.05). There was no significant variation in macronutrient consumption between the highest and lowest tertiles of hPDI. Participants who scored in the highest tertile of PDI had lower low density cholesterol level (LDL) (79.61 ± 14.36 mg dL−1 vs. 83.01 ± 14.96 mg/dL−1, P = 0.021). In addition, higher adherence to uPDI was associated with higher triglyceride (TG) levels compared to participants with lower adherence (101.5 ± 56.55 mg/dL−1 vs. 97.70 ± 56.46 mg dL−1, P < 0.0001). Here was no significant association between PDI, hPDI and uPDI and CVD risk factors in regression model. Conclusion: We found no significant association between plant-based dietary indices and CVD risk factors in women, except for LDL-C and TG. Future cohort studies are needed to confirm these findings.

Low physical activity levels 1 year after pregnancy complications.

Women with previous preeclampsia (PE), gestational hypertension (GH), or gestational diabetes mellitus (GDM) have increased cardiovascular disease (CVD) risk. Physical activity (PA) is an important CVD risk modifier. We aimed to assess PA levels, using a validated objective method, and other modifiable CVD risk factors in women with these previous pregnancy complications. One year postpartum we assessed PA levels for 1week in women with previous PE (n=68), GH (n=26), GDM (n=23), and normotensive pregnancies (n=65), using the ActiGraph-wGT3X-BT™ accelerometer. We assessed adherence to American PA guidelines (≥150min/week of moderate or ≥75min/week of vigorous intensity PA), and time spent in moderate and vigorous PA. We also assessed steps/day, blood pressure and anthropometric indices. Recommended PA levels were achieved in only 50%, 39%, and 35% following PE, GH, and GDM, respectively, not significantly different from controls (52%). Differences in moderate and vigorous PA levels and steps/day between the groups were non-significant, except from lower vigorous PA in women with previous GDM. Elevated blood pressure (systolic BP≥120mmHg and/or diastolic BP≥80mmHg) was more common after PE and GH. Overweight rates were significantly higher in PE, GH, and GDM groups compared to controls. Less than half of women achieved recommended PA levels 1year postpartum. This did not differ significantly between women with previous PE, GH, or GDM compared to controls. Measures to increase PA in postpartum women are warranted, especially in women with pregnancy complications associated with high risk of premature CVD.

Abstract 13510: Impact of Adverse Pregnancy Outcomes on Indication for Lipid Therapy in Women

Introduction: Lifetime risk for cardiovascular disease (CVD) is higher in women who experience adverse pregnancy outcomes (APOs) including pre-eclampsia, preterm birth, gestational hypertension, and gestational diabetes. APOs are risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD) in contemporary cholesterol guidelines. Hypothesis: History of APOs impacts consideration for lipid therapy in a significant proportion of women with borderline to intermediate CVD risk . Methods: A single center retrospective chart review of new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019 was performed. New female patients were routinely screened for pregnancy history with an obstetrics questionnaire, and cardiovascular history and lipid profiles were collected where available. Patients were stratified by age and calculated 10-yr risk of a cardiovascular event using the ACC/AHA Pooled Cohort Equation. APO history within age and risk categories in addition to pregnancy history documentation in electronic health records were then assessed. Results: Of the 182 new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019, average age was 49 years old and 71.3% were Caucasian. 25% of the study population had history of APO, and of patients with history of APO, only 55% had documented lipid profiles, 46% had pregnancy history documented in the obstetrics section of the electronic health record, and 17% had pregnancy history documented in their past medical history section. For patients aged 40-75 y/o with borderline-intermediate 10-yr CV event risk, risk-enhancing factors influenced consideration of potential statin therapy, with 20% of patients in the intermediate risk group having history of APO. Conclusions: Pregnancy history impacts potential statin therapy in a significant percentage of women aged 40-75 y/o with borderline-intermediate 10-yr ASCVD risk. However, APOs are often under-recognized and poorly documented as non-traditional CVD risk factors in women. Efforts to improve recognition of APOs in clinical practice should be promoted to improve CVD risk reduction efforts, particularly in young women.

Onset of cardiovascular disease risk factors in women with and without a history of breast cancer: The Pathways Heart Study.

12017 Background: Women with a history of breast cancer (BC) are at increased long-term risk of dying from cardiovascular disease (CVD). However, the onset of CVD risk factors in women with BC has not been well-described. We compared risk of incident CVD risk factors in women with and without BC enrolled in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed between 2005-2013 were identified and matched 1:5 with controls on birth year, race/ethnicity and KPNC membership at the date of BC diagnosis. Cox regression models assessed the hazard of incident hypertension (based on diagnosis codes and filled prescriptions), dyslipidemia (based on diagnosis codes, filled prescriptions, and lab values), and diabetes (KPNC Diabetes Registry). Models were adjusted for baseline BMI, menopausal status, smoking status, neighborhood median household income, education, prevalent CVD conditions, and other baseline CVD risk factors. Subgroups of women who received chemotherapy, radiation therapy, and endocrine therapy were compared with controls. Results: A total of 14,942 women with a new diagnosis of invasive BC were identified and matched to 74,702 controls. On average, women were 62.0 years, 28.3 kg/m2BMI, 64.9% non-Hispanic white. Overall, cases were more likely to develop hypertension (HR: 1.18, 95% CI: 1.13, 1.24) and diabetes (HR: 1.23, 95% CI: 1.16, 1.31). Across the board, receipt of any of the three therapies (chemotherapy, radiation therapy and endocrine therapy) was associated with increased risk of hypertension and diabetes, compared to controls. Risk-factor specific hazard ratios for receipt of chemotherapy were (HR 1.18, 95% CI: 1.10, 1.27) and (HR 1.38, 95% CI: 1.26, 1.51), for hypertension and diabetes, respectively. For receipt of radiation therapy, risk-factor specific hazard ratios were (HR: 1.17, 95% CI: 1.09, 1.26) and (HR: 1.15, 95% CI: 1.04, 1.27), for hypertension and diabetes, respectively. Risk-factor specific hazard ratios for receipt of endocrine therapy were (HR: 1.22, 95% CI: 1.14, 1.30) and (HR: 1.16, 95% CI: 1.06, 1.27), for hypertension and diabetes, respectively. Conclusions: The risk of developing hypertension and diabetes is increased in women with BC who received chemotherapy, radiation therapy, and/or endocrine therapy. Future studies should examine the roles of CVD risk factor diagnosis and management on cardiometabolic risk in women with a BC history.

The Use of Sex-Specific Factors in the Assessment of Women's Cardiovascular Risk.

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

The association of food quality score and cardiovascular diseases risk factors among women: A cross-sectional study.

Introduction: Limited studies are available regarding the relationship between Food Quality Score (FQS) and cardiovascular disease (CVD) risk factors. Thus, this study was aimed to investigate the association of FQS with CVD risk factors in women. Methods: This cross-sectional study was carried out among 368 women aged 20-50 years who randomly selected from health centers across Tehran, Iran. Dietary intake was collected using a reliable and validated food frequency questionnaire (FFQ). The FQS includes vegetables, fruits, whole grains, yogurt, nuts and legumes, coffee, refined grains, desserts and ice cream, sugar-sweetened beverages, red meats, fried food consumed outside the home, processed meats, potato and potato chips. Standard methods were used to assess blood pressure, biochemical and anthropometric measures. Multivariate logistic regression was used to examine the association between FQS and CVD risk factors. Results: Participant mean age and body mass index (BMI) were 30.7 ± 6.9 years and 24.3 ± 4.0 kg/m2, respectively. After taking potential confounders into account, FQS had no significant association with risk of overweight and obesity [Odds ratio (OR): 1.1, 95% confidence interval (CI): 0.68, 1.8; P = 0.683], diabetes (OR: 0.62, 95% CI: 0.22, 1.74; P = 0.374), metabolic syndrome (OR: 0.36, 95% CI: 0.10, 1.32; P = 0.127), hypercholesterolemia (OR: 0.54, 95% CI: 0.29, 1.01; P= 0.051), or hypertriglyceridemia (OR: 1.63, 95% CI: 0.71, 3.70; P = 0.244). Conclusion: The results showed that FQS was not significantly associated with CVD risk factors among women. Prospective cohort studies are warranted to confirm our findings.

Polycystic ovary syndrome, adipose tissue and metabolic syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder that affects women of reproductive age and is characterized by ovulatory dysfunction and/or androgen excess or polycystic ovaries. Women with PCOS present a number of systemic symptoms in addition to those related to the reproductive system. It has been associated with functional derangements in adipose tissue, metabolic syndrome, type 2 diabetes, and an increased risk of cardiovascular disease (CVD). A detailed literature search on Pubmed was done for articles about PCOS, adipokines, insulin resistance, and metabolic syndrome. Original articles, reviews, and meta-analysis were included. PCOS women are prone to visceral fat hypertrophy in the presence of androgen excess and the presence of these conditions is related to insulin resistance and worsens the PCO phenotype. Disturbed secretion of many adipocyte-derived substances (adipokines) is associated with chronic low-grade inflammation and contributes to insulin resistance. Abdominal obesity and insulin resistance stimulate ovarian and adrenal androgen production, and may further increase abdominal obesity and inflammation, thus creating a vicious cycle. The high prevalence of metabolic disorders mainly related to insulin resistance and CVD risk factors in women with PCOS highlight the need for early lifestyle changes for reducing metabolic risks in these patients.

The Relationship Between Cardiorespiratory Fitness and Aortic Stiffness in Women with Central Obesity.

To examine the association between cardiorespiratory fitness and aortic stiffness in women with central obesity. The secondary purpose was to examine whether traditional and nontraditional cardiovascular risk factors mediate the relationship between cardiorespiratory fitness and aortic stiffness. Eighty-seven centrally obese women (age, 42 ± 9 years, [body mass index (BMI)] 28 ± 3 kg/m(2)) participated in this cross-sectional study. Central obesity was defined as a waist circumference >85 cm. Pulse wave velocity (PWV) was obtained from the carotid and femoral pulse sites using applanation tonometry to measure aortic stiffness. Maximal aerobic capacity (VO2 Max) was estimated using a submaximal walk test and taken as a measure of cardiorespiratory fitness. Potential correlates of both cardiorespiratory fitness and aortic stiffness examined in this study included the following: triglycerides (TG), C-reactive protein (CRP), homeostasis model assessment of insulin resistance index (HOMA-IR), and pulsatile load (i.e., heart rate × aortic pulse pressure [aPP]). Pearson's bivariate correlations indicated that estimated VO2 Max was inversely associated with PWV (r = -0.330, p < 0.05). Using hierarchical multiple regression, the association between estimated VO2 Max and PWV was no longer significant after controlling for traditional and nontraditional cardiovascular risk factors, age, BMI, TG, CRP, HOMA-IR, and pulsatile load (β = 0.121, p > 0.05). In centrally obese women, cardiorespiratory fitness was inversely associated with aortic stiffness. Associations were not independent of traditional and nontraditional cardiovascular disease (CVD) risk factors. This suggests that higher levels of cardiorespiratory fitness may indirectly reduce aortic stiffness through its beneficial effects on traditional and nontraditional CVD risk factors in women with central obesity.

Cardiovascular Disease Risk and Breast Cancer Outcomes: A Pilot Study.

To assess feasibility of using electronic health records for profiling multiple cardiovascular disease (CVD) risk factors in women with breast cancer at diagnosis and five years post-treatment, and to explore relationships among CVD risk factors and breast cancer outcomes . Retrospective, descriptive . A comprehensive cancer center in the southwestern United States . 200 women with stage 0-III breast cancer. . A record review using an instrument to profile multiple CVD risk factors and breast cancer outcomes . CVD risk factors, such as blood pressure (BP) and hemoglobin A1C (HbA1C), and breast cancer outcomes, such as metastasis . Most data on CVD risk factors were undocumented. Even BP values to assess hypertension were missing in 35% of women at breast cancer diagnosis. Women with poor outcomes had trends toward higher blood glucose and HbA1C than women with good outcomes . The study failed to comprehensively capture CVD risk factors in women with breast cancer because of missing data. Glucose control may be associated with breast cancer outcomes . Better documentation of shared risk factors for CVD and breast cancer is needed. Prospective studies are needed to evaluate shared CVD risk factors and breast cancer outcomes because of missing health record information .

Reducing Cardiovascular Risk in Women With Lupus

Women with systemic lupus erythematosus (SLE) display a 7- to 10-fold increased risk for cardiovascular disease (CVD) compared with non-SLE controls, yet many are unaware of this risk despite years spent in the healthcare system. It is not clear why they lack awareness of increased CVD risk or which factors influence awareness. The purpose of this study was to assess in women with SLE their perceived CVD risk, the association between clinically identified and perceived CVD risk factors, and factors that influenced CVD risk awareness and adoption of risk-reducing behaviors. Questionnaires, face-to-face meetings, and clinical assessments were used to collect data on demographics, perceived CVD risk, perceived CVD risk factors, actual CVD risk factors, risk-reducing behaviors, and healthcare provider counseling from 60 women with SLE. Regression analyses identified factors that influenced risk awareness and adoption of risk-reducing behaviors. Two-thirds of the participants perceived themselves at increased CVD risk when compared with women without SLE, but the same number did not perceive an increase in their absolute CVD risk. Age was a significant predictor (P = .05) for awareness of increased absolute risk; younger age correlated with increased awareness. Most women received information about heart disease from public media. On average, participants had 4 CVD risk factors but perceived that they had only 2. Age (P = .001) and the number of perceived risk factors (P = .004) predicted adoption of risk-reducing behaviors (P = .03). Participants underestimated their CVD risk factors and did not personalize their increased CVD risk. Healthcare providers' identification and discussion of CVD risk factors in women with SLE may enhance their CVD risk awareness and the adoption of risk-reducing behaviors.

Abstract 18133: Between- and Within-Person Changes in Weight and Cardiorespiratory Fitness and the Effect on Blood Pressure and Lipids in Men and Women From the Cooper Center Longitudinal Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the U.S. Controlling risk factors such as hypertension and dyslipidemia by maintaining a healthy weight and achieving an adequate level of cardiorespiratory fitness (CRF) could result in improvements in cardiovascular health. The Cooper Center Longitudinal Study is the most extensive resource available for evaluating the simultaneous effects of changes in weight and CRF on CVD risk factors. Objective: The purpose of this study was to evaluate the within-person relationships between body weight, CRF, and CVD risk factors, while controlling for the corresponding between-person relationships. We hypothesized that increases in weight and decreases in CRF over a ten-year time period would result in detrimental effects on blood pressure and lipids, and vice-versa. Methods: The study sample consisted of 4,439 men and 651 women who had at least 5 preventive medical examinations during any ten year period from 1977 to 2006. The examination included a maximal exercise test, anthropometric and clinical measures, and a medical history questionnaire. Linear mixed-effects regression was used to model the cardiovascular risk factors over time, providing estimates of between- and within-person effects. Results: Aging alone did not significantly predict changes in CVD risk factors in women or men after adjustment for covariates including CRF and weight, with the exception of total and LDL cholesterol in men. Increases in body weight were associated with increases in systolic and diastolic blood pressure, total cholesterol, LDL, and triglycerides and decreases in HDL in women and men. The largest effect of weight gain for women and men was seen in triglycerides, with a 2.29 mg/dL and 3.57 mg/dL increase per pound of weight gained per year, respectively ( P &lt; 0.001). Increases in CRF were associated with improvements in diastolic blood pressure [-0.39 mmHg (women); -0.10 mmHg (men)] and HDL [0.35 mg/dL (women); 0.63 mg/dL (men)] over time and in triglycerides (-2.26 mg/dL) in men only ( P &lt; 0.05 for all). Conclusion: Changes in body weight over a ten year period predicted changes in all CVD risk factors examined in women and men; whereas changes in CRF predicted changes in diastolic blood pressure and HDL.

Process improvements and shared medical appointments for cardiovascular disease prevention in women

Cardiovascular disease (CVD) is clinically unique in women and is often underdiagnosed and undertreated. Chronic diseases account for 75% of healthcare expenditures in the United States, of which 70% are preventable through lifestyle changes and active medical management. Lifestyle modification is difficult in the context of the traditional medical visit. The Club Red Clinic uses a novel approach to enhance the care of women at risk for or with CVD. Through shared medical appointments (SMAs) and a multidisciplinary team approach, Club Red provides lifestyle training in addition to evidence-based practice to reduce CVD risk factors in women. In Club Red, nurse practitioners function independently and effectively in delivering lifestyle intervention for the management and prevention of CVD. The clinic functions within an academic medical school at the University of Virginia. Patient access, patient satisfaction, provider efficiency, and frequency of cardiovascular visits. Process improvements include reduced appointment wait times, improved provider efficiency (more patients seen with the SMAs), high patient satisfaction (96%), and improved adherence to recommended medical monitoring (3.8 visits/year). Club Red improved patient access, patient satisfaction, medical and behavioral management, and health promotion education for women with or at risk for CVD.

Cardiovascular Disease Risk Factors Among Women Veterans at VA Medical Facilities

ABSTRACTBACKGROUNDHypertension, hyperlipidemia, diabetes, and obesity in middle adulthood each elevate the long-term risk of cardiovascular disease (CVD). The prevalence of these conditions among women veterans is incompletely described.OBJECTIVETo describe the prevalence of CVD risk factors among women veterans in middle adulthood.DESIGNSerial cross-sectional studies of data from the Diabetes Epidemiologic Cohorts (DEpiC), a national, longitudinal data set including information on all patients in the Veterans Health Administration (VA).PARTICIPANTSWomen veterans (n = 255,891) and men veterans (n = 2,271,605) aged 35–64 receiving VA care in fiscal year (FY) 2010.MAIN MEASURESPrevalence of CVD risk factors in FY2010 by age and, for those aged 45–54 years, by race, region, period of military service, priority status, and mental illness or substance abuse; prevalence by year from 2000 to 2010 in women veterans receiving VA care in both 2000 and 2010 who were free of the factor in 2000.KEY RESULTSHypertension, hyperlipidemia, and diabetes were common among women and men, although more so among men. Hypertension was present in 13 % of women aged 35–44 years, 28 % of women aged 45–54, and 42 % of women aged 55–64. Hyperlipidemia prevalence was similar. Diabetes affected 4 % of women aged 35–44, and increased more than four-fold in prevalence to 18 % by age 55–64. The prevalence of obesity increased from 14 % to 18 % with age among women and was similarly prevalent in men. The relative rate of having two or more CVD risk factors in women compared to men increased progressively with age, from 0.55 (35–44 years) to 0.71 (45–54) to 0.73 (55–64). Most of the women with a factor present in 2010 were first diagnosed with the condition in the 10 years between 2000 and 2010.CONCLUSIONSCVD risk factors are common among women veterans aged 35–64. Future research should investigate which interventions would most effectively reduce risk in this population.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-013-2381-9) contains supplementary material, which is available to authorized users.

Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls

ObjectiveMetabolic disturbances are well-recognized clinical features of polycystic ovary syndrome (PCOS). Carotid intima-media thickness (CIMT) has been widely used as a surrogate marker of atherosclerosis and cardiovascular disease (CVD). CIMT in women with PCOS has been investigated in many studies, but there has been only one report in the Korean population. The aim of the present study was to compare the presence of subclinical atherosclerosis in young untreated Korean women with PCOS and age-matched controls, specifically by measuring their CIMT.MethodsCIMT was measured by one radiologist in 56 PCOS patients and 56 controls. To compare the CIMT according to PCOS phenotypes, women with PCOS were divided into two subgroups according to the presence of hyperandrogenism.ResultsAlthough PCOS patients were more obese and had higher blood pressure and insulin resistance index than the age-matched controls, the CIMT was not different between the two groups (0.49 ± 0.09 mm in PCOS patients vs. 0.50 ± 0.11 mm in controls, respectively, p = 0.562). When the CIMT in the control group was compared with hyperandrogenic and non-hyperandrogenic PCOS groups, also no significant differences were found.ConclusionDespite the significant differences in some vascular risk factors between women with PCOS and controls, PCOS patients did not have a significantly higher CIMT (even in the hyperandrogenic subgroups). Although our study did not show the increased risk of subclinical atherosclerosis in PCOS patients, the role of CIMT continues to be investigated considering the importance of screening and monitoring CVD risk factors in women with PCOS.

Clinical update on screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with polycystic ovary syndrome

Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in premenopausal women. This review discusses the screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with PCOS, highlighting significant recent developments. PCOS is a complex genetic disorder with multiple susceptibility genes as well as environmental factors influencing the expression of various PCOS phenotypes. The first genome-wide association study of PCOS identified susceptibility loci on chromosome 2 near the luteinizing hormone receptor gene LHCGR and chromosome 9 near the obesity gene DEEND1A. Women with PCOS are affected by a variety of metabolic disorders, including insulin resistance, metabolic syndrome, type-2 diabetes, dyslipidemia and obesity. Recently, it has been established that women with PCOS have a high risk of nonalcoholic fatty liver disease. These metabolic disturbances are associated with an increased risk of cardiovascular disease (CVD). Although women with PCOS have higher rates of cardiovascular risk factors and intermediate markers of CVD, studies definitively documenting increased CVD are lacking. The high prevalence of metabolic disorders and CVD risk factors in women with PCOS highlights the need for early screening, diagnosis and treatment of these disorders to promote long-term health and possibly prevent CVD.

312 RELATIONSHIP BETWEEN MENOPAUSE AND CARDIOVASCULAR RISK FACTORS IN MALAYSIA

Background and Objective: Menopausal women are at an increased risk of developing cardiovascular diseases (CVD). This study is to determine the association between CVD risk factors in women who are menopausal compared to non menopausal Design and methods: Community-based, cross sectional study involving 11,288 adults aged ≥ 30 years was carried out in urban and rural areas of Malaysia between 2007 and 2010. Women who were on anti-hypertensive and anti-cholesterol treatment were excluded. Multivariate logistic regression analysis was used to determine the association between CVD risk factors and menopausal status. Results: Out of the 11,288 adults, 4645 women fulfilled the inclusion criteria of whom 2086 (45%) were menopausal and 2559 (55%) were non menopausal. Mean total cholesterol (p=0.001), low density lipid (p=0.001), triglycerides (p=0.001), high systolic blood pressure (p=0.001) and diastolic blood pressure (p=0.010) were significantly higher in menopausal as compared to non-menopausal women. There was no significant difference in mean high density lipoprotein level between the two groups (p=0.839). Mean body mass index in menopausal was significantly lower as compared to non-menopausal women (p=0.001). Conclusion: Menopausal women in Malaysia have higher CVD risk profile as compared to non-menopausal women. Concerted effort must be undertaken to screen and reduce CVD risk factors in these women.

PP036. Cardiovascular disease risk factors among women with a history of placental abruption

Several studies have shown that the risk of premature cardiovascular disease (CVD) is increased after maternal placental syndromes (MPS), including hypertensive disorders and placental abruption. Although a high prevalence of CVD risk factors has been observed for women with a history of preeclampsia and pregnancy-induced hypertension, it is unclear whether patients with previous placental abruption exhibit the same cardiovascular risk profile. To investigate the association of placental abruption with the presence of modifiable CVD risk factors that may be of potential use for prevention programs. We performed a case-control study of 75 women with a history of placental abruption and a control group of 79 women with uneventful pregnancies. At 6-9months postpartum we measured the following CVD risk factors: blood pressure, body-mass index (BMI), fasting blood glucose levels, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and CRP. Baseline variables in the two groups with and without a previous abruption were expressed as means and standard deviations (SD). Where appropriate, means were adjusted for potential confounders using a generalized linear model. Data were further stratified for women with or without additional MPS-related complications, i.e. preeclampsia, gestational hypertension and intrauterine growth restriction. Women who experienced placental abruption had a significantly higher systolic and diastolic blood pressures, BMI, fasting blood glucose levels, CRP, total cholesterol, HDL-cholesterol, LDL-cholesterol and cholesterol/HDL ratio, as compared to controls. These associations remained significant in women with previous placental abruption without concomitant other MPS only for plasma lipid profile, BMI and fasting blood glucose levels, but not for diastolic and systolic blood pressure. A history of placental abruption is independently associated with increased BMI, fasting blood glucose levels, total cholesterol and LDL-cholesterol postpartum. Early detection of CVD risk factors in women with previous placental abruption offers an attractive opportunity for primary and secondary prevention.