Cardiovascular Disease Risk Profile Research Articles

The Role of Physical Activity Status in the Relationship between Obesity and Carotid Intima-Media Thickness (CIMT) in Urban South African Teachers: The SABPA Study.

Globally, the prevalence of physical inactivity and obesity are on the rise, which may increase carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis. This study assessed the association between physical activity (PA), obesity, and CIMT. A cross-sectional study design was used, including a sub-sample (n = 216) of teachers who participated in the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SAPBA) study. Measurements included the following: physical activity status (measured with ActiHeart devices over 7 consecutive days), body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), CIMT (measured by SonoSite Micromax ultrasound), blood pressure (BP), fasting C-reactive protein (CRP), and cholesterol and glucose levels. Data were analysed using the Statistical Package for Social Science. One-third of the teachers were physically inactive (33%) and had low-grade inflammation CRP ≥ 3 mg/L (41%). Males were more sedentary and had higher BP and CIMT (p < 0.05). Independent of age and sex, WC or central obesity was 2.63 times more likely (p = 0.02) to contribute to atherosclerosis, especially in females (OR: 4.23, p = 0.04). PA levels were insignificantly and negatively (β −0.034; 0.888; 0.240) related to subclinical atherosclerosis. The cardiovascular disease risk profiles and limited PA status may have curbed the beneficial impact of PA on the obesity and atherosclerosis.

Cardiovascular Disease Risk Profiles in Indonesian Athletes

BACKGROUND: Notwithstanding how physical exercise lessens cardiovascular and all-cause mortality, young and active athletes might have cardiovascular risk factors or fundamental cardiovascular diseases (CVDs), putting them at increased risk for sudden cardiac death during times of strenuous exercise.&#x0D; AIM: The study aimed to assess the cardiovascular risk profile possessed by Indonesian athletes.&#x0D; METHODS: This research was a quantitative study using a cross-sectional design, involving 234 Indonesian athletes (163 men and 71 women) from three sports, including football, basketball, and swimming. Data were collected between December 2020 to March 2021 using the Jakarta Cardiovascular Risk Score instrument adapted from the Framingham risk score. Descriptive statistics were utilized to dissect data information for frequency distribution, percentage, mean, and standard deviation.&#x0D; RESULTS: Most of the participants in this study had excessive weekly exercise duration (more than 255 minutes/week) (n=177 athletes, 75.64%). Twenty-one participants (8.97%) had a higher MAP more than normal, and 51 participants (21.79%) had overweight BMI. In addition, 142 participants (60.68%) had a cardiovascular genetic disease from their parents (family history) and most of the participants also were active smokers (n=150, 64.10%). Based on the Jakarta Cardiovascular Risk Score, the Indonesian athletes who participated in this study had a mean cardiovascular risk of -1.5 (SD= 3.088, min-max= (-7) – 6). Most of the participants had low cardiovascular risk (n= 193, 82.48%). However, some participants had moderate and high cardiovascular risk, 32 (13.67%) and 9 (3.85%), respectively.&#x0D; CONCLUSION: Most of the participants had low cardiovascular risk, however some of the participants had moderate and high cardiovascular risk.

Assessment of Surrogate Markers for Cardiovascular Disease in Familial Mediterranean Fever-Related Amyloidosis Patients Homozygous for M694V Mutation in MEFV Gene.

Cardiovascular disease (CVD) remains underestimated in familial Mediterranean fever-associated AA amyloidosis (FMF-AA). We aimed to compare early markers of endothelial dysfunction and atherosclerosis in FMF-AA with a homozygous M694V mutation (Group 1 = 76 patients) in the Mediterranean fever (MEFV) gene and in patients with other genotypes (Group 2 = 93 patients). Measures of increased risk for future CVD events and endothelial dysfunction, including flow-mediated dilatation (FMD), pentraxin-3 (PTX3), and carotid intima-media thickness (cIMT), and fibroblast growth factor 23 (FGF23) as a marker of atherosclerotic vascular disease were compared between groups. The frequency of clinical FMF manifestations did not differ between the two groups apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p < 0.05). FMD was significantly lower in Group 1 when compared with Group 2 (MD [95% CI]: −0.6 [(−0.89)–(−0.31)]). cIMT, FGF23, and PTX3 levels were higher in Group 1 (cIMT MD [95% CI]: 0.12 [0.08–0.16]; FGF23 MD [95% CI]: 12.8 [5.9–19.6]; PTX3 MD [95% CI]: 13.3 [8.9–17.5]). In patients with FMF-AA, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23, and PTX3 levels, suggesting increased CVD risk profiles. These data suggest that a genotype–phenotype association exists in terms of endothelial dysfunction and atherosclerosis in patients with FMF-AA.

Does reproductive stage impact cardiovascular disease risk factors? Results from a population-based cohort in Lausanne (CoLaus study).

Menopause has been associated with adverse cardiovascular disease (CVD) risk profile, yet it is unclear whether the changes in CVD risk factors differ by reproductive stage independently of underlying ageing trajectories. The CoLaus study is a prospective population-based cohort study in Lausanne, Switzerland. We used data from women at baseline and follow-up (mean: 5.6 ± 0.5 years) from 2003 to 2012 who did not use hormone therapy. We classified women into (i) premenopausal, (ii) menopausal transition, (iii) early (≤5 years)and (iv) late (&gt;5 years) postmenopausal by comparing their menstruation status at baseline and follow-up. We measured fasting lipids, glucoseand cardiovascular inflammatory markers. We used repeated measures (linear mixed models) for longitudinal analysis, using premenopausal women as a reference category. We adjusted analyses for age, medicationsand lifestyle factors. We used the data from 1710 women aged 35-75 years. Longitudinal analysis showed that the changes in CVD risk factors were not different in the other three menopausal categories compared to premenopausal women. When age was used as a predictor variable and adjusted for menopause status, most CVD risk factors increased, while interleukin-6 and interleukin-1β decreased with advancing age. The current study suggests that women have a worsening cardiovascular risk profile as they age, and although menopausal women may have higher levels of cardiovascular risk factors compared to premenopausal women at any given time, the 5-year changes in cardiovascular risk factors may not depend on the reproductive stage.

Cardiovascular disease risk profile of Indian young adults with type 1 diabetes compared to general population – A sub-study from the Young Diabetes Registry (YDR), India

ObjectiveWe estimated the prevalence of traditional CVD risk factors among young adults with type 1 diabetes and compared them with the general population without diabetes. MethodsParticipants were young adults (aged 20 years and above) with type 1 diabetes, from the Delhi and Chennai sites of the ICMR -Young Diabetes Registry (YDR) and their age, gender and location matched controls, without diabetes from the CARRS (Cardio metabolic Risk Reduction in South Asia) cohort. YDR and CARRS used similar standard methodologies to quantify the CVD risk factors. Linear and logistic regression models were used to compare the adjusted means and proportions of risk factors. ResultsIndividuals with type 1 diabetes had lower levels of mean BMI (21.9 kg/m2 vs 24.3 kg/m2), waist circumference (76.8 cm vs 82.1 cm), favourable lipid profile (lower LDL and higher HDL), higher mean systolic blood pressure (122.1 mmHg vs 118.7 mmHg) and hypertension (29.2% vs 21.0%), compared to controls. The extent of clustering of two or more traditional CVD risk factors was higher among general population compared to people with type 1 diabetes. ConclusionWe found that young adults with type 1 diabetes have relatively low prevalence and clustering of traditional CVD risk factors compared to general population.

Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure.

Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.

Metabolic subtypes of patients with NAFLD exhibit distinctive cardiovascular risk profiles.

We previously identified subsets of patients with NAFLD with different metabolic phenotypes. Here we align metabolomic signatures with cardiovascular disease (CVD) and genetic risk factors. We analyzed serum metabolome from 1154 individuals with biopsy-proven NAFLD, and from four mouse models of NAFLD with impaired VLDL-triglyceride (TG) secretion, and one with normal VLDL-TG secretion. We identified three metabolic subtypes: A (47%), B (27%), and C (26%). Subtype A phenocopied the metabolome of mice with impaired VLDL-TG secretion; subtype C phenocopied the metabolome of mice with normal VLDL-TG; and subtype B showed an intermediate signature. The percent of patients with NASH and fibrosis was comparable among subtypes, although subtypes B and C exhibited higher liver enzymes. Serum VLDL-TG levels and secretion rate were lower among subtype A compared with subtypes B and C. Subtype A VLDL-TG and VLDL-apolipoprotein B concentrations were independent of steatosis, whereas subtypes B and C showed an association with these parameters. Serum TG, cholesterol, VLDL, small dense LDL5,6 , and remnant lipoprotein cholesterol were lower among subtype A compared with subtypes B and C. The 10-year high risk of CVD, measured with the Framingham risk score, and the frequency of patatin-like phospholipase domain-containing protein 3 NAFLD risk allele were lower in subtype A. Metabolomic signatures identify three NAFLD subgroups, independent of histological disease severity. These signatures align with known CVD and genetic risk factors, with subtype A exhibiting a lower CVD risk profile. This may account for the variation in hepatic versus cardiovascular outcomes, offering clinically relevant risk stratification.

Cardiovascular disease (CVD) risk assessment of HIV medication regimens using hematopoietic CD34+\u2009progenitor cells

BackgroundTo determine the effects of integrase inhibitor (INSTI) in comparison with non-INSTI-based regimens such as non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimens on cardiovascular disease (CVD) risk in HIV+ patients without overt history of CVD or diabetes, with normal CD4:CD8 count. For CVD risk assessment we primarily used hematopoietic CD34+ progenitor cells, as a biomarker.MethodsNineteen male subjects, ages 32–61 years with BMI 21.0–36.0, were enrolled. This was a single time point, cross-sectional, observational study. Subjects were enrolled under 2 groups (either on INSTI-based regimen with 13 subjects or NNRTI (non-INSTI)-based regimens with 6 subjects) who were taking stable doses of HAART. The medication regimens were a combination of one NRTI (typically tenofovir–emtricitabine) plus one INSTI or NNRTI. Our outcome measures were focused on cardiovascular and endothelial cell function and systemic inflammation. Our primary outcome measures were peripheral blood-derived hematopoietic progenitor cell number (CD34 and CD133 positive), CD34+ cell function and gene expression studies. Our secondary outcomes were arterial stiffness measures and serum-based markers of inflammation.ResultsA significant increase in percentage number of progenitor cells, CD133+ cells (p = 0.004), was noted along with an increase of double progenitor mark positive CD133+/CD34+ progenitor cell population being observed in INSTI group as compared to NNRTI group, by flow cytometry. mRNA gene expression for antioxidant gene catalase was noted along with a trend toward a decrease in gene expression of inflammatory marker IL6 (p = 0.06) being observed in CD34+ from INSTI group vs NNRTI group. The plasma IL-6 and CRP levels did not change significantly between the groups. Neutrophil–Lymphocyte ratio (NLR), an important marker of inflammation, was noted to be lower in INSTI group. A mean fasting glucose level was also lower in the INSTI group compared to NNRTI group (p = 0.03). Interestingly, urine microalbumin levels were higher in the INSTI group compared to NNRTI group (p = 0.08), while eGFR levels were significantly lower in the INSTI group (p = 0.002). The arterial stiffness measures did not show statistically significant differences between the two groups.ConclusionWe conclude that the INSTI regimen may provide a better CVD risk profile compared to NNRTI-based HAART regimen; however, the increased albuminuria along with lower eGFR, noted in INSTI group, is of concern. Because of the small size, these results would need replication in additional studies before changing clinical practice.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03782142?cond=Hiv&spons=Sabyasachi+sen&cntry=US&state=US%3ADC&city=Washington&draw=2&rank=1. ClinicalTrials.gov Identifier: NCT03782142.

Morbidity and mortality in PCOS: A prospective follow-up up to a mean age above 80 years

ObjectiveDespite the clear evidence of increased cardiovascular disease (CVD) risk factors, the long-term effect on CVD and mortality is still uncertain in women with PCOS, especially in the elderly. Studies in elderly women with PCOS are lacking. The objective was to study morbidity/mortality in PCOS women compared with a reference group up to a mean age above 80 years. Study designA well-defined cohort of women with PCOS, examined in 1987 and 2008, was re-examined 32 years later in 2019 (age range 72–91 years), in parallel with an age-matched reference group. For deceased women register data was used, for women alive interviews were done, and medical records studied. Blood pressure and blood tests were analyzed. Morbidity and mortality data was available in 35/36 women with PCOS, and in 99/118 women in the reference group. ResultsAt mean age 81 years there was no difference in all-cause mortality (HR 1.1, ns), CVD-related mortality (HR 1.7, ns), all CVD (HR 1.2, ns), hypertension (HR 1.8, ns), type 2 diabetes (HR 1.7, ns), in levels of blood lipids, glucose, insulin or thyroid hormones.Comparing baseline data from the deceased and living women with PCOS, no differences were found regarding age, menopausal age, BMI, HOMA-IR, FAI, total testosterone or SHBG. However, deceased women with PCOS had a higher WHR (0.87 vs. 0.80; p-value < 0.01) at baseline. ConclusionsNo evidence of increased all-cause mortality or CVD was found in women with PCOS. The elevated testosterone levels and CVD risk profile in PCOS present during perimenopause do not seem to be associated with increased CVD morbidity/mortality risk later in life.

Assessment of the association between plant-based dietary exposures and cardiovascular disease risk profile in sub-Saharan Africa: a systematic review

BackgroundStudies have investigated dietary attributes associated with cardiovascular disease (CVD) risk in Africa. However, there has been no effort to critically assess the existing evidence. This systematic review examined available evidence on the association between plant-based dietary exposures and CVD risk profile in Africa. PROSPERO registration number: CRD42020159862.MethodsWe conducted a literature search for observational studies reporting on plant-based dietary exposures in relation to CVD risk profile in African populations. PubMed-Medline, Scopus, EBSCOhost, and African Journals Online platforms were searched up to 19 March 2021. Titles and abstracts of the identified records were screened independently by two investigators. The quality of the studies was also assessed independently.ResultsOf 458 entries identified, 15 studies published between 2002 and 2020 were included in this review. These studies originated from 12 sub-Saharan Africa (SSA) countries. Sample sizes ranged from 110 to 2362, age from 18 to 80 years; and majority of participants were females (66.0%). In all, four plant-based dietary exposures were identified across SSA. Sixty percent of the studies reported a significant association between a plant-based dietary exposure with at least one CVD risk factor such as hypertension, diabetes mellitus, dyslipidaemia, overweight/obesity, and metabolic syndrome.ConclusionsThe few available studies suggest that there may be a protective effect of plant-based dietary exposures on CVD risk profile in the African setting. Nonetheless, more elaborated studies are still needed to address plant-based diet (PBD) adherence in relation with CVD risk in African populations.

Glycoprotein Acetyls: A Novel Inflammatory Biomarker of Early Cardiovascular Risk in the Young.

BackgroundLow‐grade inflammation in the young may contribute to the early development of cardiovascular disease. We assessed whether circulating levels of glycoprotein acetyls (GlycA) were better able to predict the development of adverse cardiovascular disease risk profiles compared with the more commonly used biomarker high‐sensitivity CRP (C‐reactive protein).Methods and ResultsA total of 3306 adolescents and young adults from the Avon Longitudinal Study of Parents and Children (mean age, 15.4±0.3; n=1750) and Cardiovascular Risk in Young Finns Study (mean age, 32.1±5.0; n=1556) were included. Baseline associations between inflammatory biomarkers, body composition, cardiovascular risk factors, and subclinical measures of vascular dysfunction were assessed cross‐sectionally in both cohorts. Prospective risk of developing hypertension and metabolic syndrome during 9‐to‐10‐year follow‐up were also assessed as surrogate markers for future cardiovascular risk. GlycA showed greater within‐subject correlation over 9‐to‐10‐year follow‐up in both cohorts compared with CRP, particularly in the younger adolescent group (r=0.36 versus 0.07). In multivariable analyses, GlycA was found to associate with multiple lifestyle‐related cardiovascular disease risk factors, cardiometabolic risk factor burden, and vascular dysfunction (eg, mean difference in flow‐mediated dilation=−1.2 [−1.8, −0.7]% per z‐score increase). In contrast, CRP levels appeared predominantly driven by body mass index and showed little relationship to any measured cardiovascular risk factors or phenotypes. In both cohorts, only GlycA predicted future risk of both hypertension (risk ratio [RR], ≈1.1 per z‐score increase for both cohorts) and metabolic syndrome (RR, ≈1.2–1.3 per z‐score increase for both cohorts) in 9‐to‐10‐year follow‐up.ConclusionsLow‐grade inflammation captured by the novel biomarker GlycA is associated with adverse cardiovascular risk profiles from as early as adolescence and predicts future risk of hypertension and metabolic syndrome in up to 10‐year follow‐up. GlycA is a stable inflammatory biomarker which may capture distinct sources of inflammation in the young and may provide a more sensitive measure than CRP for detecting early cardiovascular risk.

Protocol: A randomized controlled trial to assess effectiveness of a 12-month lifestyle intervention to reduce cardiovascular disease risk in families ten years after pre-eclampsia (FINNCARE)

Pre-eclampsia (PE) is a multisystem progressive disorder affecting 3–5% of pregnancies. PE independently increases the risk for premature cardiovascular disease (CVD) in mothers and their children long-term. The effectiveness of a family-centered lifestyle intervention to lower CVD risk in PE families has not previously been evaluated. In the current FINNCARE study, we prospectively compare CVD risk and CVD progression in PE families (mother, father and child) in a cross-sectional study setting 8–12 years from delivery with non-PE control families of comparable age. Furthermore, we evaluate the effectiveness and feasibility of an interactive web-based behavioral 12-month lifestyle intervention to reduce blood pressure and the CVD risk profile overall in a randomized controlled trial. In total, 300 PE families will be randomized 1:1 to a PE-intervention or a PE-control group, and the 100 non-PE control families similarly followed-up at 12 months. Primary outcome is 24-hour mean systolic BP change from baseline in mother and child. Study aims to provide information on CVD progression and CVD risk management in the family following PE.

Branched chain amino acids are associated with metabolic complications in liver transplant recipients

BackgroundObesity, dyslipidemia and type 2 diabetes (T2D) contribute substantially to increased cardiovascular morbidity and mortality in patients after orthotopic liver transplantation (OLTx). Elevated plasma branched chain amino acids (BCAA) are linked to metabolic disturbances and cardiovascular disease (CVD) risk profiles in several non-OLTx populations. MethodsCross-sectional analysis of liver transplant recipients from TransplantLines, a single-center biobank and cohort study. BCAA plasma levels were measured by means of nuclear-magnetic resonance spectroscopy. CVD and cardiometabolic factors were collected by using data from electronic patient records. Associations were determined between BCAA plasma levels and T2D, Metabolic Syndrome (MetS), CVD as well as mTOR inhibition in liver transplant recipients. Results336 Patients were divided into sex-stratified tertiles of total BCAA. MetS (P < 0.001) and T2D (P = 0.002) were significantly more frequent in subjects in the highest BCAA tertile. In logistic regression analyses, the multivariable adjusted odds ratio (OR) per 1 standard deviation increase in BCAA was 1.68 (95%CI: 1.18–2.20, P = 0.003) for MetS and 1.60 (95%CI: 1.14–2.23, P = 0.006) for T2D. Use of Sirolimus (mTOR inhibitor) was significantly associated with higher BCAA plasma levels, independent of age, sex, time after OLTx, MetS and other immunosuppressive medication (adjusted P = 0.002). ConclusionElevated BCAA plasma levels are associated with T2D, MetS and use of Sirolimus in liver transplant recipients. BCAA plasma levels may represent a valuable biomarker for cardiometabolic complications after OLTx.

P684 Increased risk of cardiovascular disease and high risk profiles compatible with metabolic syndrome in patients with Inflammatory Bowel Disease: a cross-sectional analysis of matched cohorts

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease (CVD). This probably results from a cumulative effect of chronic inflammation and traditional CVD risk factors. We assessed the CVD risk profile of IBD patients as compared to the general population. Methods In this cross-sectional study, consecutive IBD patients aged ≥45 years were included at the Gastroenterology and Hepatology outpatient clinic. CVD risk profiles wese assessed by anthropometrics (blood pressure, length, weight, waist and hip circumference), serum analyses (nonfasting glucose and lipid spectrum) and self-administered questionnaires (history of CVD events, traditional CVD risk factors, medication use). One to four controls from the Rotterdam Study were matched to each IBD case by sex and age (scope +-5 years). Stratification was applied to asses differences between sex, IBD diagnosis and clinical disease activity (HBI or SCCAI&amp;gt;5). Results 235 IBD patients were included (44% male; median age 59 years (IQR 51–66)) and matched to 829 controls (44% male; median age 62 years (IQR 57–68)). IBD patients were more frequently diagnosed with CVD (OR 2.01, 95%CI 1.23–3.27). IBD patients showed lower odds of overweight defined as BMI ≥25 kg/m2 (OR 0.48, 95%CI 0.35–0.66) and hypercholesterolemia defined as total cholesterol ≥6.2 mmol/L, self-reported diagnosis or use of lipid lowering drugs (OR 0.45, 95%CI 0.31–0.65). The following markers of metabolic syndrome were increased in IBD patients: hypertension defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, self-reported diagnosis or use of antihypertensive drugs (OR 1.67, 95%CI 1.19–2.32), waist circumference (92 cm (SE±10) vs 88 cm (SE±8), p=.006) and triglyceride level (2.7 mmol/L (SE±0.8) vs 2.1 (SE±0.8), p&amp;lt;.001). (Table 1) Male patients had higher waist circumference, less favorable lipid profiles and were more frequently diagnosed with hypertension (OR 1.72, 95%CI 0.99–2.94) as compared to female patients. Patients with ulcerative colitis were more frequently smokers (OR 4.34, 95%CI 1.27–16.66) and showed higher odds of hypercholesterolemia (OR 1.85, 95%CI 1.06–3.33) as compared to patients with Crohn’s disease. Conclusion Patients with IBD are more frequently diagnosed with CVD as compared to age-sex matched controls. The CVD risk profile in IBD patients is characterized by components of the metabolic syndrome, i.e. hypertension, truncal obesity and hypertriglyceridemia, particularly among male IBD patients. The prevalence of other traditional CVD risk factors was comparable or even lower in IBD patients as compared to controls. The exploration of targeted preventive management strategies is required.

The Association of Heart/Vascular Aging with Mild Cognitive Impairment in a Rural Multiethnic Cohort: The Project FRONTIER Study.

Cardiovascular disease (CVD) and Alzheimer's disease and related dementias (ADRD) disproportionately affect rural communities. Identifying strategies to effectively communicate CVD risk to prevent these conditions remains a high priority. We assessed the relation between predicted heart/vascular age (PHA), an easily communicated metric of CVD risk, and mild cognitive impairment (MCI), an early manifestation of ADRD. Data were from 967 rural West Texas residents aged ≥40 years without CVD at baseline (2009-2012) enrolled in Project FRONTIER, an ongoing, multi-ethnic cohort study on cognitive aging. MCI was diagnosed using the standardized consensus review criteria. PHA was calculated using the Framingham CVD risk equation. High excess PHA (HEPHA) was defined as the difference between PHA and chronological age >5 years. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). At baseline, the mean age of participants (70% women and 64% Hispanics) was 55 years. Almost 13% had MCI and 65% had HEPHA. After adjusting for socio-demographic and health factors, HEPHA was positively associated with MCI (OR=2.98; 95%CI: 1.72-5.15). Among participants without MCI at baseline who returned for follow-up exam after three years (n=238), a three-year negative change in PHA was seemingly associated with reduced odds for MCI (OR=0.98; 95%CI: 0.96-1.01). In this study, PHA was positively associated with MCI, with improvement in CVD risk profile seemingly related to reduced odds for MCI. PHA may provide a low-cost means of communicating CVD risk in rural settings to prevent both CVD and ADRD.

Abstract- Poster

BACKGROUND (Current Scenario):Evidently, SARS-II due to COVID-19 is a problem increasing at a geometric progression affecting human civilization at large. Unfortunately there is no cure hence we are left to mercy of preventive and social medicine measures. These models of preventive and social medicine measures are dependent on available information.OBJECTIVE (Research Question):To assess the level of awareness about prevention of transmission of COVID-19 illness in community.Methodology:Cases were chosen by purposive sampling as per criteria. After screening and rating, assessment of the level of awareness about prevention of transmission of COVID-19 illness was done by structured questionnaire. The samples shall be collected from community around Burdwan Medical College and Hospital.Result: 1.Demographic characteristics(n=110) showed predominance of female subjects, mainly residing in urban area with majority educated upto higher secondary.2. Source of information was news paper, followed by news app and television.3. Majority were worried and had a close person who was affected by COVID.4.Absence of information was evident as in a scale with maximum score of 23 mean score was 15 and median 12.5.Conclusion:The accelerating rate of new case load of COVID-19 point to a gap in knowledge, attitude and practices. Hence, a deficit in knowledge is evident. Enhancement of public awareness of COVID appropriate behavior is needed for prevention of pandemic. Introduction:Death due to cardiovascular disease is one of the leading causes of mortality in persons with severe mental disorder. There is dearth of information on cardiovascular risk profile of persons with SMD.This study is done to examine the documentation of cardiovascular disease (CVD) risk profile among patients who had cardiac event during inpatient admission in a tertiary care centre.Methods:An audit of electronic medical records for documentation of CVD risk factors of smoking, alcohol use, obesity, elevated glucose levels, elevated blood pressure was done.Results:18 among 1260 in patients with Severe mental disorders had cardiac event during 2-year study period. Nearly half of them were smokers and had alcohol use disorder. Majority of them have diabetes and hypertension. There was no documentation of history of hyperlipidemia or family history of cardiometabolic risk factors in the medical records. Out of 18 who had cardiac event, 13 had elevated FBS, 10 had elevated BP, 10 had BMI>25, 9 had high HBA1C, 17 had deranged lipid profile when evaluated during hospital stay. Though some of the patients were on treatment for diabetes, hypertension and dyslipidemia, these parameters were deranged in most of them suggesting either poor compliance to medications or inadequate management.Conclusion:This study has shown that there are inadequacies in cardiovascular risk assessment and documentation in persons with severe mental disorders. Although the sample may not be representative of persons with severe mental disorders, major disparities in risk factor evaluation were found- particularly in hospitalised patients.

Bipolar Disorder and Cardiovascular Risk in Rural versus Urban Populations in Colombia: A Comparative Clinical and Epidemiological Evaluation.

Background:Various multifactorial elements may contribute toward the urban and rural disparities in cardiovascular disease (CVD) risk, particularly among patients with psychiatric diseases.Objective:To investigate whether rural patients diagnosed and treated for Bipolar Disorder (BD) have different risk profiles and outcomes of CVD compared to urban (BD) patients.Methods:We conducted a case-control study that included 125 BD patients (cases) from rural Filadelfia, Colombia and 250 BD patients (controls) treated in Bogotá, Colombia. Cases and controls were 2:1, matched by age and sex. We applied the Framingham Heart Study (FHS) risk calculator to assess risk. Differences by rural/urban status (i.e., case-control status) were assessed by chi-square, paired t-tests, and logistic regression.Findings:Rural BD patients were found to have lower education (p = 1.0 × 10–4), alcohol consumption (p = 3.0 × 10–4), smoking (p = 0.015), psychiatric (p = 1.0 × 10–4) and CV family history (p = 0.0042) compared to urban BD patients. Rural BD patients were 81% more likely to have a more favorable CVD risk profile (OR: 0.19, 95% CI [0.06–0.62]) than urban BD patients, despite rural BD patients having increased CVD morbidity (p = 1.0 × 10–2).Conclusion:Based on increase in morbidity but lower predictive risk in the rural population, our study suggests that the FHS-CVD calculator may not be optimal to assess CVD risk in this population.

Abstract 11530: Cardiovascular Risk Profile and Preterm Birth by Maternal Nativity in Racially Diverse, Urban, Low Income Women in the United States

Introduction: Preterm Birth (PTB) is an independent risk factor for future cardiovascular disease (CVD). Nativity-related disparities in CVD risk profile and risk of PTB have been shown among non-Hispanic Black (NHB) women; however, studies exploring these disparities among women of other races are limited. We hypothesized that foreign-born NHB, White, and Hispanic women will have better CVD risk profile and lower risk of PTB compared to their US-born counterparts. Methods: We utilized data from 6096 women with mean age 27.5(±6.3) years in the Boston Birth Cohort who self-identified as NHB (2699), White (997), or Hispanic (2400). We examined differences in sociodemographic characteristics and CVD risk factors such as smoking, obesity, and hypertension by nativity status. Using multivariable logistic regression models, we examined the association of nativity and length of U.S. residence with PTB by race. Results: Of the total sample, 27.2% delivered preterm (29.1%, 29.8%, and 24.1% among NHB, White, and Hispanic women, respectively). Compared to foreign-born women, US-born women in each of the three racial groups were younger and more likely to be obese, single, smoke in pregnancy, and report severe stress. After adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women had lower odds of PTB compared to U.S-born NHB women (adjusted odds ratio, aOR: 0.79; 95%CI: 0.65-0.97). Similarly, foreign-born Hispanic women had lower odds of PTB compared to U.S-born Hispanic women (aOR: 0.72; 95%CI: 0.56-0.93). In all 3 racial groups, shorter (&lt;10 years), but not longer (≥10 years) length of U.S. residence was associated with lower odds of PTB. (Figure) Conclusions: US-born women in all three racial groups had a higher prevalence of CVD risk factors including smoking, obesity, and stress, compared to foreign-born women. The “foreign-born advantage” which is protective of PTB was not observed among foreign-born women with ≥10 years of U.S. stay.

Abstract 13992: Cardiovascular Disease Risk of Abnormal Glucose Tolerance Depends on Etiology: Insulin Resistance versus Beta-Cell Failure

Background: Cardiovascular disease (CVD) and abnormal glucose tolerance (Abnl-GT) are rapidly increasing in sub-Saharan Africa. Abnl-GT is a primary risk factor for CVD. Yet, different Abnl-GT etiologies, insulin resistance (IR) or β-cell failure, may have different CVD risk profiles. Therefore, in 493 African-born Blacks living in the United States [male: 64%, age: 38±10y (mean±SD)], we evaluated the CVD risk profile within each Abnl-GT etiology. Methods: OGTT were performed. Abnl-GT, a term combining diabetes and prediabetes, was defined as fasting plasma glucose (FPG)≥100 mg/dL and/or glucose at 2h≥140 mg/dL. IR was defined by the upper quartile of HOMA-IR (≥2.03). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell failure was defined as Abnl-GT without IR. Fasting lipids, including high-density lipoprotein (HDL), low-density lipoprotein (LDL) particle sizes, were measured. Dyslipidemia was defined as total cholesterol, TC&gt;200mg/dL, LDL&gt;130mg/dL, HDL&lt;35mg/dL and triglycerides, TG&gt;150mg/dL or any combination thereof. CVD risk was determined by the Pooled-Cohort Equation (PCE) [age, TC, HDL, SBP, diabetes, smoking status], as developed in the ARIC cohort. Results: Abnl-GT occurred in 37% (183/493) of participants, with Abnl-GT due to IR in 28% (69/183) and β-cell-failure in 62% (114/183). Neither systolic nor diastolic BP differed between the Abnl-GT groups (both P &gt;0.05). HDL, HDL-size and LDL-size were lower and TG higher in the IR group compared to the β-cell-failure group (all P &lt;0.01). The prevalence of dyslipidemia was higher in the IR than the β-cell-failure group at 49% (34/69) vs 28% (32/114) ( P &lt;0.05). The IR had a higher PCE score versus the β-cell failure group [26.5±2.7 vs 18.8.0±1.9 ( P =0.001)]. Conclusions: Although IR was a less common cause of Abnl-GT than β-cell failure, the IR group had a more adverse lipid profile and therefore a higher CVD risk compared to the β-cell failure group. Thus, the etiology of Abnl-GT should be taken into account when developing treatment strategies for patients at higher CVD risk.

Abstract 9150: Actigraphy-Derived Sleep Health Metrics and Biomarkers of Cardiovascular Disease Risk in Black/African American Smokers

Introduction: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in Black/African American (BAA) adults, and to a greater extent in BAAs who smoke cigarettes. Sleep is an emergent predictor of CVD, yet the independent role of sleep health on CVD risk in BAA smokers is unclear. Thus, we tested the hypothesis that better sleep health metrics would be independently associated with more favorable biomarkers of CVD risk in midlife BAA smokers. Methods: BAA adults (n=226, 55.9±6.1y, 44% male) who were current smokers (≥1 cigarette in last month) without sleep-disordered breathing or severe lung disease completed 14 days of wrist actigraphy to assess sleep duration, efficiency, midpoint, and regularity (sleep midpoint standard deviation). Resting blood pressure (BP) and heart rate recovery (HRR; HR peak minus HR 1-min recovery from submaximal exercise) were assessed. Hypertension was defined as resting BP ≥130/80 mmHg, or use of antihypertensives. Multivariable regression models of systolic BP, diastolic BP, hypertension (yes/no), and HRR were generated to test associations between sleep metrics and CVD risk markers after adjusting for key covariates (see Table). Results: In adjusted models, achieving a healthy sleep duration (6-8 h/night) was associated with 62% lower odds of hypertension (vs. &lt;6 or &gt;8h/night; OR=0.38, 95% CI=0.18-0.75). Later sleep midpoint was associated with higher systolic BP (B=1.97 mmHg per 1-h delay in midpoint, 95% CI=0.17-3.81); longer sleep duration (B=1.89 bpm per 1-h increase in duration, 95% CI=0.39-3.39) and greater sleep efficiency (B=0.27 bpm per 1% increase in efficiency, 95% CI=0.08-0.46) were associated with greater HRR. Conclusions: Better sleep health metrics are associated with a lower CVD risk profile in BAA smokers, independent of important confounding factors. Sleep health may represent an auxiliary intervention target for ameliorating the CVD burden experienced by this at-risk group.