Individual Cardiovascular Disease Risk Research Articles

Nutritional status, food intake and cardiovascular disease risk in individuals with schizophrenia in southern Brazil: A case–control study

ObjectivesTo verify food consumption patterns and presence of risk anthropometric parameters in schizophrenic patients, trying to assess some modifiable cardiovascular risk. MethodTwenty-five schizophrenic outpatients, attended at the Hospital de Clínicas de Porto Alegre, Brazil, and 25 healthy controls matched by sex, age and body mass index (BMI) were included. Demographic (age, sex and socioeconomic status), anthropometric (weight, height and waist circumference), clinical (antipsychotics) and dietary consumption data (food frequency questionnaire) were obtained. ResultsThere was a 40% frequency of overweight and 40% of obesity as verified by BMI, and 80% of increased risk of metabolic complications as measured by waist circumference. Most of the patients (68%) used atypical antipsychotics and no association was found between the distribution of the nutritional status according to BMI and type of antipsychotic used. There was a higher intake of total calories, calories and protein per kilogram of body weight, percentage of carbohydrates, and lower intake of omega-6, phytosterols, vitamin A and α-tocopherol by cases. Cholesterol and sodium intake did not differ between groups (365±152mg of cholesterol in cases and 313±146mg in controls; (3499±1695mg sodium by cases and 2874±800 by controls). ConclusionIn this sample of schizophrenic patients there was a higher intake of calories and lower consumption of α-tocoferol and phitosterols, compared to controls. There was also elevated sodium, and cholesterol intake, and high frequency of overweight and central obesity.

Impact of Health Counselling on Cardiovascular Disease Risk in Middle Aged Men: Influence of Socioeconomic Status

BackgroundThe inverse association between socioeconomic status and cardiovascular disease is well documented. We examined whether the impact of health counselling on cardiovascular risk factors in middle-aged men differed according to socioeconomic status.MethodsWe used data from a community based study assessing the risk for cardiovascular disease among middle-aged men in Helsinki, Finland. Traditional cardiovascular disease risk factors were measured and cardiovascular disease risk was assessed by a modified risk tool used in the North Karelia project (CVD Risk Score). Those men with increased risk for cardiovascular disease at their baseline visit in 2006 received lifestyle counselling. After two years these high-risk men were invited to a follow-up visit. The same measurements and risk assessments were repeated.ResultsBased on the CVD Risk Score there were significant differences between the groups at baseline (p = 0.001) and at follow-up (p<0.001) with the highest scores in the lowest educational group. There were no significant differences in traditional cardiovascular risk factors according to educational attainment between groups either at baseline or at follow-up. Baseline lifestyle characteristics differed between the groups regarding use of soft fat (p = 0.019). All groups responded positively to lifestyle counselling.ConclusionsThe present study showed that lifestyle counselling is feasible in high-risk middle-aged men and lifestyle intervention works in all educational groups. Interestingly the traditional risk factors did not show improvement, but the risk score improved. From a practical point of view our findings stress the importance of using risk score calculators in health counselling instead of looking at individual cardiovascular disease risk factors.

Effect of 24 Weeks of Statin Therapy on Systemic and Vascular Inflammation in HIV-Infected Subjects Receiving Antiretroviral Therapy

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of cardiovascular disease (CVD) due in part to inflammation. Statins decrease inflammation in the general population, but their effect during HIV infection is largely unknown. This is an ongoing randomized, double-blinded, placebo-controlled trial to evaluate the effect of statin therapy on inflammatory markers during HIV infection. Subjects received rosuvastatin 10 mg daily or placebo for 24 weeks. Subjects were receiving stable (>12 weeks) antiretroviral therapy and had a low-density lipoprotein (LDL) cholesterol level of ≤130 mg/dL and evidence of heightened immune activation or inflammation. This was a prespecified interim analysis. A total of 147 subjects were enrolled (78% were male, 70% were black, and the median age was 47 years). By 24 weeks, LDL cholesterol levels had decreased in the statin group, compared with an increase in the placebo group (-28% vs +3.8%; P < .01). A 10% reduction in the lipoprotein-associated phospholipase A2 (Lp-PLA2) level was seen in the statin group, compared with a 2% reduction in the placebo group (P < .01). In multivariable regression, receipt of statin treatment and having a nadir CD4(+) T-cell count of ≤100 cell/µL were the only statistically significant predictors of a decrease in Lp-PLA2 level. Markers of systemic inflammation did not change significantly between groups. Twenty-four weeks of rosuvastatin therapy significantly decreased the level of Lp-PLA2, a vascular-specific, inflammatory enzyme that predicts cardiovascular events in the general population. Statins may hold promise as a means of attenuating CVD risk in HIV-infected individuals by decreasing Lp-PLA2 levels.

Switching from Abacavir/Lamivudine to Tenofovir DF/Emtricitabine Reduces Biomarkers of Inflammation: A Randomized Proof of Concept Study

Background: Abacavir use has been associated with cardiovascular disease (CVD) risk, but this effect has not been consistent across studies. Methods: To explore abacavir-related CVD risk we studied 27 HIV-positive participants taking fixed-dose abacavir/ lamivudine-based antiretroviral therapy (ART) with viral suppression and randomized them to remain on their current regimen (n=13) or switch the nucleoside component to tenofovir disoproxil fumarate (DF)/emtricitabine (n=14). Plasma biomarkers were measured at baseline and at 1 and 6 months. Results: At baseline, median (IQR) age was 46 years (41-53) and CD4+ count 620 cells/mm3 (477-836). There were no baseline differences in individual CVD risk factors between groups, however, 10-year Framingham Risk Score (FRS) trended higher for those taking abacavir (8.5%) versus tenofovir DF (4.7%). Switching to a tenofovir DF-based ART regimen, compared with staying on abacavir-based ART, was associated with a 79% lower level of high sensitivity C-reactive protein (hsCRP; p=0.04) and a 52% lower inflammatory/coagulation rank composite (consisting of hsCRP, interleukin-6 and D-dimer levels). These findings were not attenuated after adjusting for 10-year FRS (-79% for hsCRP, p=0.06; -50% for inflammatory composite, p=0.003). Conclusion: Larger, prospective, randomized studies are needed to verify whether switching from abacavir/ lamivudine- to tenofovir DF/emtricitabine-based ART, in the context of viral suppression, reduces inflammation and corresponding CVD risk.

Performance of Framingham cardiovascular disease (CVD) predictions in the Rotterdam Study taking into account competing risks and disentangling CVD into coronary heart disease (CHD) and stroke

BackgroundTo evaluate the performance of Framingham predictions of cardiovascular disease (CVD) risk corrected for the competing risk of non-CVD death, in an independent European cohort of older individuals and subsequently extend the predictions by disentangling CVD into coronary heart disease (CHD) and stroke separately. MethodsWe used the Rotterdam Study data, a prospective cohort study of individuals aged 55years and older (N=6004), to validate the Framingham predictions of CVD, defined as first occurrence of myocardial infarction, coronary death or stroke during 15years of follow-up, corrected for the competing risk of non-CVD death. We subsequently estimated the risks of CHD and stroke separately, and used the sum as a predictor for the total CVD risk. Calibration plots and c-statistics were used to evaluate the performance of the models. ResultsPerformance of the Framingham predictions was good in the low- to intermediate risk (≤30%, 15-year CVD risk) (17.5% observed vs. 16.6% expected) but poorer in the higher risk (>30%) categories (36.3% observed vs. 44.1% expected). The c-statistic increased from 0.66 to 0.69 after refitting. Separately estimating CHD and stroke revealed considerable heterogeneity with regard to the contribution of CHD and stroke to total CVD risk. ConclusionsFramingham CVD risk predictions perform well in the low- to intermediate risk categories in the Rotterdam Study. Disentangling CVD into CHD and stroke separately provides additional information about the individual contribution of CHD and stroke to total individual CVD risk.

Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.

LETTER TO THE EDITOR: Dietary Assessment and Cardiovascular Disease Risk Scores

According to a recently published editorial article in the Open Hypertension Journal written by Anagnostis et al., [1] adherence to a Mediterranean type diet was associated with reduced cardiovascular disease (CVD) risk, by modulating arterial blood pressure levels. Hypertension consist, both a traditional risk factor with increasing prevalence among older subjects [2] and specific subpopulations (i.e., metabolic syndrome) as well as a high-yield target in means of primary and secondary prevention. The common CVD risk scores (e.g., Framingham score sheet, ESC SCORE) [3,4] that are implicated in individual CVD risk assessment through easily measured characteristics constantly incorporate arterial blood pressure indices in underlying estimation models [3,4]. Accumulating evidence [5] suggests that adherence to healthier dietary patterns is associated with favorable CVD profile; i.e., in 2008 the INTERHEART study with approximately 16,500 participants concluded that 30% of CVD deaths in Europe could have been prevented through adoption of healthier dietary habits [6]. Despite emerging associations between dietary patterns and CVD risk, diet’s assessment has never been, directly, incorporated into existing CVD risk scores [5]. Researchers who added diet’s assessment into CVD risk estimation models, reported incremental value of the dietary component over traditional risk factors in terms of overall model performance and improved reclassification of the true events [7,8]. In addition, updating CVD risk estimation scores with dietary information could improve the correct classification rate of people at high risk. This suggestion is further reinforced by the aforementioned editorial, which identifies unhealthy dietary patterns as a risk factor for adverse CVD events, independently of blood pressure status and lipid profile. The individual CVD risk estimation is highly recommended by the European guidelines for the majority of middle- aged people, even without known CVD history [9]. Under this context, classification rate improvement of the existing CVD risk estimation scores should be addressed as a cardinal issue in terms of public health policies. Dietary patterns assessment should be examined as the most promising candidate parameter for incorporation into the existing CVD risk estimation scores in order to upgrade current prevention strategies.

Dose Response Association between Physical Activity and Biological, Demographic, and Perceptions of Health Variables

Background: Few population-based studies have examined the association between physical activity (PA) and cardiovascular disease risk factors, demographic variables, and perceptions of health status, and we do not have a clear understanding of the dose-response relationship among these variables. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey was used to examine the dose-response relationship between objectively measured PA and metabolic syndrome (and its individual cardiovascular disease risk factors), demographic variables, and perceptions of health. After exclusions, 5,538 participants 18 years or older were included in the present study, with 2,538 participants providing fasting glucose and 2,527 providing fasting triglyceride data. PA was categorized into deciles. Results: Overall, the health benefits showed a general pattern of increase with each increasing levels of PA. Of the ten PA classifications examined, participants in the highest moderate-to-vigorous physical activity (MVPA) category (at least 71 min/day) had the lowest odds of developing metabolic syndrome. Conclusion: At a minimum, sedentary adults should strive to meet current PA guidelines (i.e., 150 min/week of MVPA), with additional positive benefits associated with engaging in three times this level of PA.

Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study

BackgroundCardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.MethodsIn a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.ResultsAfter a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.ConclusionsWomen with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.

Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): Results after one year

ObjectiveWe aimed to assess whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. MethodsWe extracted data from patients aged 40–74years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. We included 4748 patients at baseline (July 2008–November 2009), with 3712 at follow-up (December 2009–March 2011). We used a pre–post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check. ResultsThere were significant reductions in mean CVD risk score (28.2%; 95% confidence interval (CI)=27.3–29.1 to 26.2%; 95% CI, 25.4–27.1), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increased from 14.0% (95% CI=11.9–16.0) to 60.6% (95% CI=57.7–63.5). ConclusionsThe introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals. Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the program can make significant changes to population health.

Viewpoint: Personalizing Statin Therapy

Cardiovascular disease (CVD), associated with vascular atherosclerosis, is the major cause of death in Western societies. Current risk estimation tools, such as Framingham Risk Score (FRS), based on evaluation of multiple standard risk factors, are limited in assessment of individual risk. The majority (about 70%) of the general population is classified as low FRS where the individual risk for CVD is often underestimated but, on the other hand, cholesterol lowering with statin is often excessively administered. Adverse effects of statin therapy, such as muscle pain, affect a large proportion of the treated patients and have a significant influence on their quality of life.Coronary artery calcification (CAC), as assessed by computed tomography, carotid artery intima-media thickness (CIMT), and especially presence of plaques as assessed by B-mode ultrasound are directly correlated with increased risk for cardiovascular events and provide accurate and relevant information for individual risk assessment. Absence of vascular pathology as assessed by these imaging methods has a very high negative predictive value and therefore could be used as a method to reduce significantly the number of subjects who, in our opinion, would not benefit from statins and only suffer from their side-effects.In summary, we suggest that in very-low-risk subjects, with the exception of subjects with low FRS with a family history of coronary artery disease (CAD) at young age, if vascular imaging shows no CAC or normal CIMT without plaques, statin treatment need not be administered.

Genome damage in peripheral blood lymphocytes of diabetic and non-diabetic individuals after intervention with vegetables and plant oil

Recent studies suggest increased cancer risk in patients with type 2 diabetes mellitus (T2DM) compared with healthy individuals. The present study aims to assess whether T2DM is associated with increased genome instability and whether a healthy diet with natural foods can improve genome stability in peripheral blood lymphocytes (PBLs). Seventy-six diabetic and 21 non-diabetic individuals were randomly assigned to either an 'intervention' or an 'information only' group. All participants received information about the beneficial effects of a healthy diet, while subjects of the intervention group received additionally 300g of vegetables and 25ml of plant oil rich in polyunsaturated fatty acids per day for 8 weeks. Chromosomal damage was assessed using the cytokinesis-block micronucleus (MN) cytome assay. Levels of chromosomal damage did not differ between diabetic and non-diabetic individuals. However, diabetic individuals with MN frequency above the high 50th percentile had significantly higher levels of fasting plasma glucose, glycosylated haemoglobin and were at higher risk for cardiovascular disease (CVD), assessed by the Framingham general cardiovascular risk score. Non-diabetic individuals with MN frequency above the 50th percentile had significantly lower vitamin B12 levels. The intervention with vegetables and plant oil led to significant increases in folate, γ-tocopherol, α- and β-carotene while vitamin B12 was significantly reduced. Levels of chromosomal damage were not altered, only apoptosis was slightly increased. The results suggest interactions between glycaemic control, CVD risk and genome stability in individuals with T2DM. However, a healthy diet does not improve genome damage in PBLs.

Prediabetes: A Prevalent and Treatable, but Often Unrecognized, Clinical Condition

Type 2 diabetes mellitus (T2DM) affects more than 8% of the United States population.1 The onset of T2DM is gradual, with most individuals progressing through a state of pre-diabetes which is defined as impaired fasting glucose (IFG; plasma glucose of 100–125 mg/dl or 5.6–6.9 mmol/l) and/or impaired glucose tolerance (IGT; plasma glucose of 140–199 mg/dl or 7.8–11.0 mmol/l 2h after an oral load of 75g dextrose) and/or hemoglobin A1C 5.7–6.4%.2 According to a study of a nationally representative sample (n =1,547), an estimated 35% of the United States population suffers from pre-diabetes: 19% have IFG only, 5% have IGT only, and 10% have both IFG and IGT.3 Although individuals can spend years in a pre-diabetic state, an expert American Diabetes Association (ADA) panel estimated that up to 70% will eventually progress to T2DM.4 However, not all individuals with pre-diabetes progress at the same rate. A meta-analysis of prospective cohort studies showed that the annual incidence of diabetes in people with IGT, IFG, or both was 6.1%, 7.0%, and 14.0% respectively.5 The diagnosis of pre-diabetes presents healthcare providers with an opportunity to identify patients at increased risk for T2DM and to implement interventions that can delay or prevent T2DM and its complications.4 Unfortunately, this opportunity is often unrecognized, as an analysis of a nationally representative sample of patients with pre-diabetes (n=584) concluded that only 31.7%, 33.4%, 25.9% had been counseled about exercise, diet, or both, respectively by a doctor or health professional.3 Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.6, 7 However, individuals who have been counseled by their health-care provider to adopt a healthy lifestyle reported greater adherence to weight control and diet modification and had lower low density lipoprotein (LDL) cholesterol, lower body mass index (BMI), and higher high density lipoprotein (HDL) cholesterol.8 Still, it is unclear whether counseling sessions by a primary care provider in the outpatient setting are correlated with improvements in fasting plasma glucose in patients with pre-diabetes compared to similar patients who have not been counseled. While there is some evidence to suggest lifestyle counseling may be associated with self-reported changes in lifestyle behavior in overweight and obese adults with pre-diabetes and diabetes,9 other data suggest that lifestyle intervention programs that have been implemented in the outpatient healthcare setting have had an insignificant impact on fasting plasma glucose.6 Nevertheless, according to ADA guidelines there is clear evidence to support providing medical nutrition therapy as needed to patients with pre-diabetes.10 Given the high prevalence of pre-diabetes, it is important to understand the basic underlying pathophysiology and how lifestyle interventions can be implemented in the clinical setting to reduce a patient’s risk for developing T2DM.

Plasma homocysteine levels increase following stress in older but not younger men

The incidence and prevalence of cardiovascular disease (CVD) increases with age. Some evidence suggests that mental stress may increase plasma homocysteine (Hcy), an amino acid relating to CVD. However, none of these studies assessed age effects on Hcy stress reactivity, nor did they control for age. The objective of this study was (a) to investigate whether Hcy reactivity to psychosocial stress differs between younger and middle-aged to older men and (b) to study whether psychosocial stress induces Hcy increases independent of age. Twenty eight younger (20-30 years) and 22 middle-aged to older (47-65 years) apparently healthy men underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. Blood samples for Hcy measurements were obtained immediately before and after, as well as 10 and 20min after stress. Moreover, salivary cortisol was repeatedly measured to test the effectiveness of the stress task in triggering a neuroendocrine stress response. Hcy reactivity to stress differed between age groups (F(1.4, 60.7)=5.41, p=.014). While the older group displayed an increase in the Hcy response to stress (F(2.5, 39.8)=3.86, p=.022), Hcy levels in the younger group did not change (p=.27). Psychosocial stress per se did not change Hcy levels independent of age (p=.53). Our findings suggest that psychosocial stress does not evoke an Hcy response per se, but only in interaction with age pointing to a mechanism by which mental stress may increase CVD risk in older individuals.

Hemoglobin A1c Is Positively Correlated with Framingham Risk Score in Older, Apparently Healthy Nondiabetic Korean Adults

BackgroundSeveral studies have suggested that elevated levels of hemoglobin A1c (HbA1c) are associated with cardiovascular disease (CVD) in nondiabetic individuals. However, it is unclear whether HbA1c levels can serve as a simple screening marker for increased CVD risk in nondiabetic individuals. Our objective was to evaluate the relationship between HbA1c levels and CVD risk using the Framingham risk score (FRS) in older, apparently healthy nondiabetic Korean adults.MethodsWe retrospectively studied 2,879 Korean adults between the ages of 40 and 79 who underwent voluntary health check-ups at the Health Promotion Center of our hospital from July 2009 to June 2011. Subjects were subdivided based on their HbA1c levels into four groups: tertiles within the HbA1c normal tolerance range and a group for subjects with an increased risk for diabetes (IRD).ResultsThe mean FRS for the upper tertile (9.6±3.8) group was significantly higher than that of the middle tertile (8.4±4.0) and lower tertile (7.6±3.8) groups. In addition, FRS was highest in the IRD group (10.5±3.7). Multiple linear regression analysis demonstrated that HbA1c levels exhibited a significant positive correlation with FRS when adjusted for confounding variables in all subjects (β±standard error [SE], 0.018±0.002; R2, 0.131), women (β±SE, 0.023±0.003; R2, 0.170), and men (β±SE, 0.016±0.004; R2, 0.109).ConclusionHbA1c levels were positively correlated with FRS in older, apparently healthy nondiabetic Korean adults. We propose that HbA1c levels may reflect CVD risk in nondiabetic individuals.

Sustained and Shorter Bouts of Physical Activity Are Related to Cardiovascular Health

Whereas greater physical activity (PA) is known to prevent cardiovascular disease (CVD), the relative importance of performing PA in sustained bouts of activity versus shorter bouts of activity on CVD risk is not known. The objective of this study was to investigate the relationship between moderate-to-vigorous PA (MVPA), measured in bouts ≥10 and <10 min, and CVD risk factors in a well-characterized community-based sample of white adults. We conducted a cross-sectional analysis of 2109 participants in the Third Generation Cohort of the Framingham Heart Study (mean age = 47 yr, 55% women) who underwent objective assessment of PA by accelerometry over 5-7 d. Total MVPA, MVPA done in bouts ≥10 min (MVPA(10+)), and MVPA done in bouts <10 min (MVPA(<10)) were calculated. MVPA exposures were related to individual CVD risk factors, including measures of adiposity and blood lipid and glucose levels, using linear and logistic regression. Total MVPA was significantly associated with higher HDL levels and with lower triglycerides, BMI, waist circumference, and Framingham risk score (P < 0.0001). MVPA(<10) showed similar statistically significant associations with these CVD risk factors (P < 0.001). Compliance with national guidelines (≥150 min of total MVPA) was significantly related to lower BMI, triglycerides, Framingham risk score, waist circumference, higher HDL, and a lower prevalence of obesity and impaired fasting glucose (P < 0.001 for all). Our cross-sectional observations on a large middle-age community-based sample confirm a positive association of MVPA with a healthier CVD risk factor profile and indicate that accruing PA in bouts <10 min may favorably influence cardiometabolic risk. Additional investigations are warranted to confirm our findings.

Assessment of Cardiovascular Disease Risk in South Asian Populations

Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.

Correlation between mean platelet volume and total risk of cardiovascular disease

Introduction. The association between mean platelet volume (MPV) and single cardiovascular disease (CVD) risk factors has previously been tested. The aim of our study was to evaluate the association between MPV and total risk of CVD. Materials and Methods. In 216 consecutive outpatients referred for a cardiology assessment because of multiple CVD risk factors, total CVD risk was estimated according to the Framingham Risk Score (FRS) as low ( 20%). Additionally, FRS was adjusted for triglycerides (TG), body mass index (BMI) and a family history of CVD, important CVD risk factors which are not included in the FRS equation. Also, CVD risk was estimated according to terciles of MPV ( 9.1 fL, respectively). Correlation between high sensitivity C-reactive protein (hs-CRP) and FRS was used as confirmation that our study hypothesis was properly set. Results. MPV did not correlate with individual CVD risk factors or with FRS, either before, or after adjustment for additional CVD risk factors. Significant correlation between MPV and total CV risk was observed only in the adjusted high FRS group ; namely, for persons in tercile 3, CVD risk was doubled (OR 2.2 ; 95% CI 1.05-4.64 ; P =0.038). In comparison, there was a strong linear correlation between hs-CRP and unadjusted (r=0.203, P=0.004) and adjusted (r=0.383, P<0.001) FRS. Conclusion. Correlation between MPV and high total CVD risk suggests increased platelet activity primarily as a consequence and sign of atherosclerotic vascular damage. Linear correlation between hs-CRP with FRS confirms inflammation as an important mechanism of atherogenesis.

Determinants of HbA1c in nondiabetic Dutch adults: genetic loci and clinical and lifestyle parameters, and their interactions in the lifelines cohort study

Glycated haemoglobin (HbA1c) is associated with cardiovascular disease risk in individuals without diabetes, and its use has been recommended for diagnosing diabetes. Therefore, it is important to gain further understanding of the determinants of HbA1c. The aim of this study was to investigate the effects of genetic loci and clinical and lifestyle parameters, and their interactions, on HbA1c in nondiabetic adults. Population-based cohort study. Three northern provinces of the Netherlands. A total of 2921 nondiabetic adults participating in the population-based LifeLines Cohort Study. Body mass index (BMI), waist circumference, HbA1c, fasting plasma glucose (FPG) and erythrocyte indices were measured. Data on current smoking and alcohol consumption were collected through questionnaires. Genome-wide genotyping was performed, and 12 previously identified single-nucleotide polymorphisms (SNPs) were selected for replication and categorized as 'glycaemic' and 'nonglycaemic' SNPs according to their presumed mechanism(s) of action on HbA1c. Genetic risk scores (GRSs) were calculated as the sum of the weighted effect of HbA1c-increasing alleles. Age, gender, BMI, FPG, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, current smoking and alcohol consumption were independent predictors of HbA1c, together explaining 26.2% of the variance in HbA1c, with FPG contributing 10.9%. We replicated three of the previously identified SNPs and the GRSs were also found to be independently associated with HbA1c. We found a smaller effect of the 'nonglycaemic GRS' in females compared with males and an attenuation of the effect of the GRS of all 12 SNPs with increasing BMI. Our results suggest that a substantial portion of HbA1c is determined by nonglycaemic factors. This should be taken into account when considering the use of HbA1c as a diagnostic test for diabetes.

Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis

Background and objectivesLow cardiorespiratory fitness (CRF) is a significant predictor of cardiovascular disease (CVD), and interventions aiming at increasing CRF are known to reduce CVD risk. The effects of such...