Cardiovascular Disease Risk Profile Research Articles

Adipokines and Subclinical Cardiovascular Disease in Post-Menopausal Women: Study of Women's Health Across the Nation.

BackgroundThe menopausal transition is characterized by increased cardiovascular risk, weight gain, and increased adiposity for many women. The adipose‐derived secretory proteins adiponectin and leptin are associated with insulin resistance, metabolic syndrome, and cardiovascular disease but their role in subclinical atherosclerotic disease is unclear. This cross‐sectional study evaluated the associations of adiponectin and leptin with carotid artery intima‐media thickness, adventitial diameter, presence of carotid plaques, and brachial‐ankle pulse wave velocity (baPWV) in women aged 54 to 65 years.Methods and ResultsParticipants were 1399 women from SWAN (Study of Women's Health Across the Nation), a community‐based study of women transitioning through menopause. Carotid ultrasound and baPWV measures were obtained at SWAN follow‐up visits 12 or 13, when 97% of participants were post‐menopausal. Adipokines were assayed from serum specimens obtained concurrently at these visits. Linear and logistic regression models were used to evaluate adiponectin or leptin, both log‐transformed attributable to skewness, in relationship to carotid artery intima‐media thickness, adventitial diameter, baPWV, and presence of carotid plaque. Covariates included age, race, study site, smoking, alcohol use, obesity, cardiovascular disease risk factors, and menopausal status. Lower levels of adiponectin were related to greater carotid artery intima‐media thickness, wider adventitial diameter, and faster baPWV; associations were attenuated after adjusting for cardiovascular disease risk factors. Higher levels of leptin were associated with greater carotid artery intima‐media thickness and wider adventitial diameter in minimally and fully adjusted models, and contrary to expectation, with slower baPWV, particularly among women with diabetes mellitus or obesity.ConclusionsAdiponectin and leptin are 2 important inflammatory pathways that may contribute to adverse subclinical cardiovascular disease risk profiles in women at midlife.

Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data.

Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.

Gender Differences in the Association Between Serum Uric Acid and Arteriosclerotic Cardiovascular Risk Among Chinese Type 2 Diabetes Mellitus Patients.

Background and ObjectivesSerum uric acid (sUA) level has been reported to be associated with arteriosclerotic cardiovascular risk, yet remains poorly defined in Chinese type 2 diabetes patients. The purpose of the current study was to evaluate gender differences in the association between sUA level and arteriosclerotic cardiovascular risk in Chinese type 2 diabetes patients.MethodsThe cross-sectional study was conducted in six community health service centers in Shanghai, China from December 2014 to December 2016. A stratified random sampling method was used to recruit participants. From a total of 3977 type 2 diabetic patients, 2537 were included for the analysis of the association between sUA level and arteriosclerotic cardiovascular risk. Clinical and biochemical data were obtained from participants. Arteriosclerotic cardiovascular risk was evaluated by the ten-year risk profile for arteriosclerotic cardiovascular disease. The associations between sUA level and arteriosclerotic cardiovascular risk were assessed via multiple logistic regression.ResultsOf the 2537 participants, the average sUA level was 317±77umol/L in men and 294±73 umol/L in women, and 54.8% (1391/2537) of participants had high ten-year risk of arteriosclerotic cardiovascular disease (ASCVD), which was ≥20%. High ten-year risk of ASCVD odds ratio was increased by 1.596 (95% CI, 1.113–2.289, p for trend 0.004) comparing fourth to first quartiles of sUA in women. However, no significant association was found between sUA and high ten-year risk of ASCVD in men.ConclusionThis community-based study indicated that sUA levels were independently associated with high ten-year risk of ASCVD in women with type 2 diabetes mellitus, but not in men.

Combined Associations of Serum Ferritin and Body Size Phenotypes With Cardiovascular Risk Profiles: A Chinese Population-Based Study.

Background: Serum ferritin (SF) has been correlated with one or more metabolic syndrome features associated with an increased risk for cardiovascular disease (CVD). This study explored the associations between SF and CVD risk factors among different body size phenotypes that were based on metabolic status and body mass index (BMI) categories.Methods: A cross-sectional study was performed using a cohort of 7,549 Chinese adults from the China Health and Nutrition Survey. Participants did not exhibit acute inflammation, were not underweight and were stratified based on their metabolic status and BMI categories. The metabolically at-risk status was defined as having two or more criteria of the Adult Treatment Panel-III metabolic syndrome definition, excluding waist circumference.Results: Compared with individuals without high SF, subjects with high SF had an increased risk of diabetes in the metabolically at-risk normal-weight (MANW) and metabolically at-risk overweight/obesity (MAO) groups. The multivariate-adjusted odds ratios (ORs) were 1.52 [95% confidence interval (Cls): 1.02, 2.28] and 1.63 (95% Cls: 1.27, 2.09), respectively. Adjusted ORs for hyperuricemia from high SF in metabolically healthy normal-weight (MHNW), metabolically healthy overweight/obesity (MHO), MANW, and MAO phenotypes were 1.78 (95% Cls: 1.26, 2.53), 1.42 (95% Cls: 1.03, 1.95), 1.66 (95% Cls: 1.17, 2.36), and 1.42 (95% Cls: 1.17, 1.73), respectively. Similarly, positive correlations of high SF with triglycerides, non-high-density lipoprotein cholesterol, and apolipoprotein B100 were observed in all phenotypes. No association between high SF and elevated low-density lipoprotein cholesterol were observed among participants who were metabolically at-risk, regardless of their BMI categories. However, the ORs for elevated low-density lipoprotein cholesterol from high SF were 1.64 (95% Cls: 1.29, 2.08) in the MHNW group and 1.52 (95% Cls:1.22, 1.91) in the MHO group, significantly. This study demonstrated that the highest ORs were in MAO with a high SF group for all unfavorable CVD risk factors except low-density lipoprotein cholesterol (all p < 0.001).Conclusions: The associations of high SF with the prevalence of CVD risk factors, including diabetes, dyslipidemia, and hyperuricemia, vary in individuals among different body size phenotypes. In the MAO group, subjects with high SF levels exhibited worse CVD risk profiles than individuals without high SF.

Association of serum uric acid with waist-hip ratio: A promising index for assessing cardiovascular disease risk profile

Association of serum uric acid with waist-hip ratio: A promising index for assessing cardiovascular disease risk profile

Examining Cardiovascular Disease Risk Profiles Among Older Adults With and Without Fibromyalgia

Introduction: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality in the United States. Preexisting chronic health conditions may be confer increased CVD risk, specifically fibromyalgia (FM), a chronic condition characterized by widespread pain, fatigue, stiffness, and concentration problems. CVD risk increases with normal aging; however, characteristics of FM are suggested to exacerbate health profiles in normal aging processes that may contribute to increased CVD risk. Method: The sample included 221 older adults (M=63.40, SD=8.86; 82% female; 88% White/European American) and 55% reported an FM diagnosis. CVD risk factors were entered separately in a five-block hierarchical binary logistic regression model as predictors and included: cardiorespiratory fitness using the six-minute walk, BMI, standing and lying mean arterial pressure (MAP), and depression using the Beck Depression Inventory. Results: Logistic regression analyses revealed that poorer cardiorespiratory fitness (OR=.99, 95% CI=.99-1.00, p=.001), greater depressive symptoms (OR=1.35, 95% CI=1.19-1.53, p< .001) and lower standing MAP (OR=.98, 95% CI=.96-1.00, p=.036) were associated with higher odds of an FM diagnosis. However, no differences in lying MAP (OR=1.02, 95% CI=1.00-1.04, p=.137) or BMI (OR=1.02, 95% CI=.95-1.10, p=.644) for an FM diagnosis emerged. Discussion: These data support the importance of examining the health profiles of persons with FM in the context of CVD risk. Experiences of FM may produce distinct health profiles with characteristics that serve as both protective and risk factors in the context of CVD.

Trends in cardiorespiratory fitness among apparently healthy adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST) cohort from 1970-2019.

IntroductionCardiorespiratory fitness (CRF) is a strong independent predictor of cardiovascular disease (CVD) and CVD mortality. However, little is known in regards to how CRF has trended in apparently healthy adults over the past several decades.PurposeTo analyze trends in CRF and CVD risk factors over the last 50 years in a population of apparently healthy adult men and women.MethodsParticipants were 4,214 apparently healthy adults (2,390 men and 1,824 women) from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST) that performed maximal cardiopulmonary exercise testing between 1970–2019 for the assessment of CRF defined as VO2max (ml/kg/min). Participants were self-referred either to a community-based exercise program, fitness testing, or were research subjects in exercise related studies and were placed into groups by decade based on testing date.ResultsCRF showed a general trend to decline (P<0.05) from the 1970s to the 2000s with an increase (P<0.05) from the 2000s to the 2010s for both men and women. This pattern persisted for age and sex-adjusted CRF level, determined by Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). For both women and men, CRF across the decades was associated (P<0.05) with the prevalence of physical inactivity, smoking, obesity, dyslipidemia and hypertension, and with diabetes in men only.ConclusionCRF declined from 1970 through the 2000s in a cohort of apparently healthy men and women which was associated with worsening CVD risk profiles. However, the decline in CRF was attenuated over the past decade which may have a positive impact on future CVD in the population. Promoting physical activity to increase CRF should be a primary aspect of CVD prevention programs.

Abstract 14434: Identification and Predictors for Cardiovascular Disease Risk Equivalents Among Adults With Diabetes Mellitus

Background: It is not well quantified if diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent depends on DM severity and other CVD risk factors. Methods: We pooled 4 US community-based cohorts (ARIC, JHS, MESA, FHS Offspring) and classified subjects by baseline DM/CVD status. DM+/CVD- was further classified by DM duration, HbA1c control or DM medication. Hazard ratios (HR) were estimated for CVD during a median follow-up of 14 years. Subgroup analysis comparing the HR of DM+/CVD- vs. DM-/CVD+ was done by CVD risk factors. We integrated all factors that impacted DM-conferred CVD risk and defined one with DM+/CVD- as CVD risk equivalent when his/her CVD risk was as high or higher than that if he/she had DM-/CVD+. CVD risk profile and event risk were compared between the CVD risk equivalent subgroups in DM+/CVD-. Results: The pooled cohort included 27,732 adults (mean age of 58 years, 45% males). CVD event rates per 1000 P-Y were 16.3, 33.3, 40.9 and 69.0 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. DM participants with HbA1c≥7%, DM duration over 10 years, or DM medication use had similar CVD risk as those with DM-/CVD+ while those without these factors had lower CVD risk; DM+/CVD- had similar CVD risk as those DM-/CVD+ among women, age &lt;55 years, White race, or high triglyceride groups (Figure). Among those with DM+/CVD-, 17.5% were found to be CVD risk equivalents. Compared to those non-CVD risk equivalent DM, they had lower 10-year PCE scores (14.8% vs. 22.7%, p&lt;0.0001) however higher actual CVD event rates (44.9 vs. 31.0 per 1000 P-Y). Conclusion: Among CVD-free adults with DM, fewer than 20% are actually CVD risk equivalents. Poor HbA1c control, long DM duration, and current diabetes medication use were identified as predictors of CVD risk equivalent status and DM was more detrimental for CVD risk if one is female, younger age, White, or with high triglycerides. These risk enhancing factors should be considered in the treatment decision.

Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light?

Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.

Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.

90 Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as &lt;46000 CAD/annum; low education was defined as a neighborhood in which &lt;80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P &lt; .001) and those with low income (30.4% vs 25.9%,P &lt; .001) or low educational attainment (30.7% vs 27.6%,P &lt; .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P &lt; .001), low income (OR,1.17;95%CI,1.12-1.21;P &lt; .001) and low education (OR,1.08;95%CI,1.04-1.11;P &lt; .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]

Associations between body mass index trajectories in childhood and cardiovascular risk factors in adulthood

Background and aimsChildren with a growth trajectory of overweight have higher levels of cardiovascular disease (CVD) risk factors than children with a normal-weight trajectory. However, less is known about how trajectories of body mass index (BMI) across the rest of the BMI spectrum relate to CVD risk factors and whether adult BMI affects these associations. Our aim was to examine associations between childhood BMI trajectories and adult CVD risk factors. MethodsWe included 2466 individuals with childhood weights and heights (ages 6–14) from the Copenhagen School Health Records Register and adult CVD risk factors (ages 20–81) from the Copenhagen City Heart Study. Associations between childhood BMI trajectories identified by latent class modelling and CVD risk factors were examined using generalized linear regression analyses with and without adjustment for adult BMI. Normal-weight and overweight were defined by growth references from the Centers for Disease Control and Prevention. ResultsWe identified four childhood trajectories within the normal-weight spectrum and one trajectory of overweight. Compared to the trajectory with the lowest BMI level, several higher BMI trajectories were associated with worse circumference, HDL and glucose homeostasis in adulthood. The highest trajectory was additionally associated with higher total cholesterol and triglycerides. When adjusting for adult BMI, the higher BMI trajectories had lower waist circumference, blood pressure and triglycerides. ConclusionsTrajectories of BMI within the normal-weight range and in the overweight range are associated with a worse CVD risk profile than in the lowest BMI trajectory, and these associations are modifiable by growth after childhood.

Obstetrical Complications and Long-Term Cardiovascular Outcomes

Obstetrical complications including indicated preterm birth (PTB), hypertension (HTN), IUGR, and GDM are risk factors for future cardiovascular disease. To identify patients at risk, the American Heart Association recommends obtaining a detailed obstetric history. Our objective was to determine if non-OB-GYN physicians-in-training obtain an obstetric history when assessing a risk profile for cardiovascular disease and to identify differences based on level of training. In 2019, an anonymous survey was distributed to trainees in internal medicine, cardiology, endocrinology, nephrology, and neurology. Subjects were queried about frequency of asking a history of PTB, IUGR, GDM, and HTN in pregnancy. Survey options were always/frequently/sometimes/rarely/never and were categorized into two groups: "ask" (always/frequently/sometimes) vs. "do not ask" (rarely/never). Comparisons between specialties and levels of training were made using chi-square and Fisher's exact test. Comparisons within subjects were made using McNemar's test. The response rate was 64% (210 total possible participants), including 98 internal medicine residents and 37 fellows in cardiology (21), endocrinology (3), nephrology (8), and neurology (5). Asking about medical complications (HTN + GDM) was significantly more common than asking about OB complications (PTB + IUGR) (p < 0.001). Internal medicine residents were less likely than subspecialty fellows to ask about HTN (31% vs. 70%; p < 0.001). There were no differences in likelihood of eliciting OB history based on PGY level. An OB history can identify risk factors for cardiovascular morbidity. Our data demonstrates that physicians caring for women lack awareness on the association between complications in pregnancy and cardiovascular health.

Risk factors for cardiovascular disease in a healthy young population: Family matters

BackgroundIndia faces an epidemic of cardiovascular disease (CVD). This study sought the effect of family history of CVD and/or its risk factors (CVD-risk) on the presence of risk factors for CVD, in a healthy young college population. MethodsBlood pressure (BP), heart rate (HR), anthropometric variables, fasting blood sugar and lipid fractions were measured in two hundred healthy individuals (163 men and 37 women), aged 17–22 years. Data were analysed to elicit effect of CVD-risk on measured parameters. ResultsAll but one subject, had family history of a CVD-risk. Men with family history of coronary heart disease had higher diastolic BP (79.24 ± 7.7 vs 75.99 ± 7.49 mmHg, p = 0.007) and triglycerides (118.66 ± 57.98 vs 85.82 ± 50.89 mg/dL, p < 0.0001) compared with those without similar family history. Men with family history of hypertension (HTN) had higher diastolic BP (78.75 ± 7.15 vs 75.84 ± 8.37 mmHg, p = 0.019) and low-density lipoprotein (86.24 ± 25.38 vs 78.21 ± 17.93 mg/dL, p = 0.019), as well as lower high-density lipoprotein (50.27 ± 8.4 vs 53.96 ± 10.38 mg/dL, p = 0.019). Women with family history of diabetes mellitus had lower high-density lipoproteins (49.89 ± 8.05 vs 59.53 ± 11.44, p = 0.006). Family history of dyslipidaemia was associated with significantly higher triglycerides (146.14 ± 46.19 vs 98.44 ± 56.19 mg/dL, p = 0.002) in men and in subjects across sex. HDL was contrarily higher, in women with family history of cerebrovascular accident/HTN and men with family history of coronary heart disease/HTN. The proportion of pre-HTN, overweight/obese, impaired fasting glucose and borderline high triglycerides was 88.3%, 36.8%, 11% and 38.7% in men and 64.9%, 37.8%, 18.9% and 48.7% in female subjects. ConclusionYoung adults with a family history of CVD-risk already have an incomplete/atypical CVD risk profile.

Quantitative thoracic aorta calcification assessment by 18F-NaF PET/CT and its correlation with atherosclerotic cardiovascular disorders and increasing age.

We aimed to assess the correlation between age and cardiovascular risk factors with NaF-PET/CT imaging in the thoracic aorta (TA). In this prospective study, 80 healthy controls and 44 patients with chest pain underwent NaF-PET/CT imaging, and three segments of the aorta (ascending, arch, and descending) were examined. Average SUVmax, SUVmean, and Alavi-Carlsen Score (ACS) were calculated in each segment and the entire vessel. The degree of NaF uptake in controls and patients and its correlation with age were determined. Multivariate linear regression and logistic regression models were employed to determine the predictabilities of Framingham Risk Score (FRS) and unfavorable cardiovascular disease (CVD) risk profile by these measurements. Average SUVmax, average SUVmean, and ACS were significantly higher in patients than in controls, and all correlated well with age. The correlation of average SUVmean with age was significant in both controls (r = 0.32, p = 0.04) and patients (r = 0.64, p < 0.001). ACS of the entire TA was a stronger predictor of FRS compared with average SUVmax and average SUVmean (adjusted R2 = 0.38, standardized β = 0.58, p < 0.001). ACS was a significant predictor of unfavorable CVD risk profile as compared with other values (odds ratio = 1.006, 95% CI = 1.000-1.013, p = 0.05). Active calcification in TA correlates with age, and its correlation is higher among subjects with CVD risk factors. Global assessment (ACS) can predict unfavorable CVD risk profile. These data provide evidence for the potential role of NaF in assessing micro-calcification in arteries and its relations to cardiovascular events. • Global micro-calcification in the thoracic aorta as measured by NaF-PET/CT imaging correlates with increasing age. • The extent of the correlation was higher among patients with cardiovascular disease (CVD) risk factors. • These data provide evidence for the potential role of NaF in assessing active calcification in arteries and its relations to cardiovascular events.

Effects of phytoestrogen supplementation on intermediate cardiovascular disease risk factors among postmenopausal women: a meta-analysis of randomized controlled trials.

Phytoestrogens are becoming popular constituents of human diets and are increasingly used by postmenopausal women. Our study aims to determine the effects of phytoestrogen supplementation on intermediate cardiovascular disease (CVD) risk factors in postmenopausal women. Five electronic databases (Medline, EMBASE, Web of Science, Cochrane CENTRAL, Google Scholar) were systematically searched to identify eligible studies, that is, randomized controlled trials (RCTs) that assessed the association of phytoestrogen supplementation with CVD risk factors (serum lipids, homocysteine, fibrinogen, markers of inflammation, oxidative stress and endothelial function, carotid intima-media thickness [CIMT]) in postmenopausal women. Data were extracted by two independent reviewers using a predefined data collection form. In total, 56 RCTs were identified, including 4,039 individual postmenopausal women. There was substantial heterogeneity in quality across studies. Twenty-six (46%) RCTs showed poor quality and there was an indication of publication bias presence for some of the biomarkers. Results are reported in pooled mean difference (95% CI) of changes. Use of phytoestrogens was associated with a decrease in serum total cholesterol (-0.27 mmol/L [-0.41 to -0.13]), low-density lipoprotein (-0.25 mmol/L [-0.37 to -0.13]), triglycerides (-0.20 mmol/L [-0.28 to -0.11]), and apolipoprotein B (-0.13 g/L [-0.23 to -0.03]) and with an increase in serum apolipoprotein A-1 (0.04 g/L [0.02-0.07]. Also, phytoestrogen supplementation was associated with a decrease in serum intercellular adhesion molecule 1 (-18.86 ng/mL [-30.06 to -7.65]) and E-selectin (-2.32 ng/mL [-4.05 to -0.59]). There was no association observed between phytoestrogen supplementation and inflammatory markers, fibrinogen, homocysteine, or other endothelial function markers. In contrast, use of phytoestrogens was associated with an increase in CIMT (9.34 μm [95% CI, 0.39-18.29]). Effect estimates of phytoestrogen supplementation on oxidative stress could not be pooled. Phytoestrogen supplementation seems to modestly improve the CVD risk profile of postmenopausal women by influencing blood lipids and parameters of endothelial function. In women with an increased risk of atherosclerosis, although modest, a harmful effect on CIMT progression may be present. Because of limited quality and the heterogeneous nature of the current evidence, additional rigorous studies are needed to explore the role of phytoestrogens in menopausal cardiovascular health. : Video Summary: http://links.lww.com/MENO/A593.

A realist evaluation approach to explaining the role of context in the impact of a complex eHealth intervention for improving prevention of cardiovascular disease

BackgroundReduction of cardiovascular disease (CVD) is a worldwide health priority and innovative uses of technology-based interventions may assist patients with improving prevention behaviours. Targeting these interventions to recipients most likely to benefit requires understanding how contexts of use influence responsiveness to the intervention, and how this interaction favours or discourages health behaviour. Using a realist evaluation approach, the aim of this study was to examine the contextual factors influencing behaviour change within a multi-feature eHealth intervention with personalised data integration from the primary care electronic health record (EHR).MethodsRealist evaluation of qualitative data from the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised trial (N = 934). Thirty-six participants from the intervention group (N = 486) who had completed 12 months of study follow-up were interviewed. Coding of transcripts was structured around configurations of contexts, mechanisms, and outcomes of intervention use. Contextual narratives were derived from thematic analysis of the interviews.ResultsMechanisms favouring positive health behaviour occurred when participants responded to four interactive features of the intervention. Facilitating mechanisms included greater cognitive engagement whereby participants perceived value and benefit, and felt motivated, confident and incentivised. Participants moved from being unconcerned (or unaware) to more task-oriented engagement with personal CVD risk profile and prevention. Increased personalisation occurred when modifiable CVD risk factors became relatable to lifestyle behaviour; and experiences of feeling greater agency/self-efficacy emerged. Use and non-use of the intervention were influenced by four overarching narratives within the individual’s micro-level and meso-level environments: illness experiences; receptiveness to risk and prevention information; history of the doctor-patient relationship; and relationship with technology.ConclusionsIntervention-context interactions are central to understanding how change mechanisms activate within complex interventions to exert their impact on recipients. Intervention use and non-use were context-dependent, underscoring the need for further research to target eHealth innovations to those most likely to benefit.

Frailty status and cardiovascular disease risk profile in middle-aged and older females.

Frailty and pre-frailty are known to increase the risk of developing cardiovascular disease (CVD). However, the risk profiles of females are not well characterized. The aim of this study is to characterize the CVD risk profiles of robust, pre-frail and frail females. Cross-sectional analysis of 985 females ≥55years with no self-reported history of CVD were recruited. Frailty was assessed using the Fried Criteria with the cut-points standardized to the cohort. Framingham risk scores (FRS), the 4-test Rasmussen Disease Score (RDS), and the CANHEART health index were used to characterize composite CVD risk. Individual measures of CVD risk included blood lipids, artery elasticity assessments, exercise blood pressure response, 6-min walk test (6MWT), sedentary time and PHQ-9 score. The cohort comprised of 458 (46.4%) robust, 464 (47.1%) pre-frail and 63 (6.4%) frail females with a mean age of 66±6 (SD) years. Pre-frail females were at increased odds of taking diabetes medications (OR 3.04; 95% CI 1.27-7.27), hypertension medications (OR 2.02; 95% CI 1.44-2.82), having an exaggerated blood pressure response to exercise (OR 1.878; 95% CI 1.39-2.50), mild depression symptoms (OR 2.38; 95% CI 1.68-338), and lower fitness as assessed by 6MWT (OR 5.74; 95% CI 3.18-10.37), even after controlling for age and relevant medications. Pre-frail females were also at increased odds for having CVD risk scores indicating higher risk with the FRS (OR 1.52; 95% CI 1.12-2.05), the RDS (OR 1.60; 95% CI 1.21-2.10) and the CANHEART risk score (OR 3.07; 95% CI 2.04-4.62). These odds were higher when frail females were compared to their robust peers. Frailty and pre-frailty were associated with higher odds of presenting with CVD risk factors as compared to robust females, even after controlling for age.

Attenuation of exaggerated blood pressure responses to exercise: a byproduct of improved vascular function with passive heat therapy?

Attenuation of exaggerated blood pressure responses to exercise: a byproduct of improved vascular function with passive heat therapy?

Weight Change In Firefighters And Associated Changes In Cardiovascular Disease Risk Factors Over Five Years

Obesity is a substantial risk factor (RF) for cardiovascular disease (CVD), and research suggests that 23-35% of firefighters (FFs) have a body mass index (BMI) categorized as obese. To date, limited research has examined weight change and associated changes in CVD RFs among FFs. PURPOSE: To assess changes in body weight and CVD RFs among an occupationally active cohort of US FFs over a 5-year period, and to investigate changes in CVD RFs in FFs who lost weight, maintained a stable weight, or gained weight. METHODS: Changes in CVD RFs (e.g., BMI, blood pressure [BP], total cholesterol [TC], low and high density lipoproteins [LDL; HDL], and blood glucose [BG]) were measured during two occupational medical exams an average of 4.8±0.6 years apart in a cohort of 672 active FFs. Changes in CVD RFs within subgroups of FFs who lost >3% body weight, maintained stable weight (±3% body weight), or gained >3% body weight were tested for statistical significance using paired t-tests. RESULTS: FFs on average had a significant increase (p<0.001) in BMI (0.8kg/m2), TC (5.5mg·dl-1), LDL (5.2mg·dl-1), and BG (2.1mg·dl-1). FFs who gained weight had a significant increase (p<0.001) in TC (12.9mg·dl-1), LDL (11.1mg·dl-1), and BG (2.9mg·dl-1) with a significant decrease (p≤0.05) in HDL (-1.3mg·dl-1). In contrast, FFs who lost weight showed a significant decrease (p≤0.05) in TC (-8.5mg·dl-1), LDL (-8.5mg·dl-1), and BP (systolic: -5.3mmHg; diastolic -4.2mmHg) with a significant increase (p≤0.05) in HDL (2.3mg·dl-1). There were significant changes (p<0.001) among weight stable FFs in BP (systolic: -3.5mmHg; diastolic: -3.8mmHg), and BG (2.7mg·dl-1). CONCLUSION: On average, FFs gained weight and CVD RFs worsened over 5 years. However, a large proportion of FFs (12%) lost weight or maintained weight (38%), and weight loss was associated with improvements in CVD risk profiles. In contrast, FFs who gained weight (50%) had significant detrimental changes in several CVD RFs. These results support the importance of weight maintenance and weight loss for the prevention of CVD in the fire service. Supported by AFG Grant EMW 2017-FP-00445

Assessment of the association of plant-based diets with cardiovascular disease risk profile in Africa: a systematic review and meta-analysis protocol.

IntroductionCardiovascular disease (CVD) is currently the leading cause of death worldwide. In Africa where infectious diseases are still the leading cause of death, the contribution of non-communicable diseases led by CVDs has significantly increased in recent years. The rise of CVDs in Africa is attributed at least in part to the adoption of sedentary behaviours and unhealthy eating habits, which are linked with urbanisation and westernisation of cultures. Dietary attributes associated with CVD risk have been less investigated in Africa. However, evidence from developed nations has reported a protective effect of healthy dietary patterns such as plant-based diets (PBDs) on cardiometabolic health. The current protocol is for a review aiming to assess existing evidence on the association of PBDs with CVD risk profile in African populations.Methods and analysisThis protocol was developed following the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will conduct a comprehensive search of the literature for published studies on PBDs in relation to CVD risk profile in African populations. Observational studies published between January 1990 and December 2019 will be screened. A search strategy using keywords and medical subject headings terms will be applied across multiple scientific databases including PubMed-Medline, Scopus and EBSCOhost and the African Journals Online platform. Manual searches of reference lists from relevant articles will be performed. Citations will be traced using the ISI Web of Science to further identify eligible studies. Grey literature will also be screened for relevant abstracts from conference proceedings, and experts in the field will be contacted where appropriate. Two investigators will independently screen all the titles and abstracts to determine which records are eligible for full-text review. Subsequently, two investigators will review the eligible full text using the selection criteria. A third investigator will be consulted to resolve any discrepancies. Data will be extracted from studies that are eligible for the review. Meta-analysis will be performed for studies with similar or comparable methods and reported outcome measures. This will be performed overall, and by major study-level characteristics. Heterogeneity in the estimates across studies will be assessed and quantified with the use of Cochrane Q and I2 statistics, respectively. Publication biases will be investigated through funnel plots and Egger test of bias. Relevant sensitivity analyses will be performed to confirm the robustness of the findings.Ethics and disseminationThe review will analyse data from published studies; therefore, it does not require ethical approval. The findings of the review will be submitted as part of a PhD thesis at Stellenbosch University, South Africa. Additionally, the findings will be presented at conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42020159862.