Cardiovascular Disease Mortality Research Articles

Association between hyperuricemia and the risk of mortality in patients with osteoarthritis: A study based on the National Health and Nutrition Examination Survey database.

The purpose of this study was to evaluate the relationship between hyperuricemia and the risks of all-cause mortality and cardiovascular disease (CVD) mortality in patients with osteoarthritis (OA). A retrospective cohort study was performed on 3,971 patients using data from the National Health and Nutrition Examination Survey database between 1999 and 2018. OA was diagnosed through specific questions and responses. The weighted COX regression models were used to explore the factors associated with all-cause mortality/CVD mortality in OA patients. Subgroup analyses were conducted based on age, gender, hypertension, dyslipidemia, CVD, and chronic kidney disease (CKD). Hazard ratio (HR) and 95% confidence interval (95% CI) were measured as the evaluation indexes. During the duration of follow-up time (116.38 ± 2.19 months), 33.69% (1,338 patients) experienced all-cause mortality, and 11.36% (451 patients) died from CVD. Hyperuricemia was associated with higher risks of all-cause mortality (HR: 1.22, 95% CI: 1.06-1.41, P = 0.008) and CVD mortality (HR: 1.32, 95% CI: 1.02-1.72, P = 0.036) in OA patients. Subgroup analyses showed that hyperuricemia was related to the risk of all-cause mortality in OA patients aged >65 years (HR: 1.17, 95% CI: 1.01-1.36, P = 0.042), in all male patients (HR: 1.41, 95% CI: 1.10-1.80, P = 0.006), those diagnosed with hypertension (HR: 1.17, 95% CI: 1.01-1.37, P = 0.049), dyslipidemia (HR: 1.18, 95% CI: 1.01-1.39, P = 0.041), CVD (HR: 1.30, 95% CI: 1.09-1.55, P = 0.004), and CKD (HR: 1.31, 95% CI: 1.01-1.70, P = 0.046). The association between hyperuricemia and a higher risk of CVD mortality was found in OA patients aged ≤ 65 years (HR: 1.90, 95% CI: 1.06-3.41, P = 0.032), who did not suffer from diabetes (HR: 1.36, 95% CI: 1.01-1.86, P = 0.048), who did not suffer from hypertension (HR: 2.56, 95% CI: 1.12-5.86, P = 0.026), and who did not suffer from dyslipidemia (HR: 2.39, 95% CI: 1.15-4.97, P = 0.020). These findings emphasize the importance of monitoring serum uric acid levels in OA patients for potentially reducing mortality associated with the disease.

Association of diabetic retinopathy on all-cause and cause-specific mortality in older adults with diabetes: National Health and Nutrition Examination Survey, 2005–2008

To evaluate the effect of diabetic retinopathy (DR) status or severity on all-cause and cause-specific mortality among diabetic older adults in the United States using the most recent National Health and Nutrition Examination Survey (NHANES) follow-up mortality data. The severity of DR was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale. Multiple covariate-adjusted Cox proportional hazards regression models, Fine and Gray competing risk regression models, and propensity score matching (PSM) methods were used to assess the risk of all-cause and cause-specific mortality in individuals with diabetes. All analyses adopted the weighted data and complex stratified design approach proposed by the NHANES guidelines. Time to death was calculated based on the time between baseline and date of death or December 31, 2019, whichever came first. Ultimately 1077 participants, representing 3,025,316 US non-hospitalized individuals with diabetes, were included in the final analysis. After a median follow-up of 12.24 years (IQR, 11.16–13.49), 379 participants were considered deceased from all-causes, with 43.90% suffering from DR, including mild DR (41.50%), moderate to severe DR (46.77%), and proliferative DR (PDR) (67.21%). DR was associated with increased all-cause, cardiovascular disease (CVD) and diabetes mellitus (DM)-specific mortality, which remained consistent after propensity score matching (PSM). Results of DR grading assessment suggested that the presence of mild, moderate to severe NPDR was significantly associated with increased risk of all-cause and CVD-specific mortality, while the presence and severity of any DR was associated with increased DM-specific mortality, with a positive trend. The presence of DR in elderly individuals with diabetes is significantly associated with the elevated all-cause and CVD mortality. The grading or severity of DR may reflect the severity of cardiovascular disease status and overall mortality risk in patients with diabetes.

Extracellular matrix turnover proteins as risk markers in people with type 2 diabetes and microalbuminuria

BackgroundThis post-hoc study investigated whether biomarkers reflecting extracellular matrix (ECM) turnover predicted cardiovascular disease (CVD), mortality, and progression of diabetic kidney disease (DKD) in individuals with type 2 diabetes (T2D) and microalbuminuria. MethodsSerum levels of specific ECM turnover biomarkers were assessed in 192 participants with T2D and microalbuminuria from an observational study conducted at Steno Diabetes Center Copenhagen from 2007 to 2008. Endpoints included CVD events, mortality, and DKD progression, defined as decline in estimated glomerular filtration rate (eGFR) of >30 %. ResultsParticipants had a mean age of 59 years, with 75 % males. Over a median follow-up of 4.9 to 6.3 years, the study recorded 38 CVD events, 24 deaths, and 40 DKD events. Elevated levels of a degradation fragment of collagen type I (C1M) were associated with an increased risk of >30 % eGFR decline, although this association was not independent of other risk factors. No significant associations were found between other ECM turnover biomarkers and DKD progression, mortality, or CVD risk. ConclusionElevated C1M levels were linked to DKD progression in individuals with T2D and microalbuminuria, but not independently of other risk factors. None of the ECM turnover biomarkers were associated with CVD or mortality.

Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality

BackgroundCholine, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S.MethodsThis study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations.ResultsIn our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60–0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk.ConclusionElevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.

Fatherhood and Cardiovascular Health, Disease, and Mortality: Associations From the Multi-Ethnic Study of Atherosclerosis

IntroductionEmerging literature links fatherhood to men's health, but lacks comprehensive assessment of health outcomes, especially among multi-ethnic populations. Our objective was to evaluate the associations of fatherhood (age at onset and status) with cardiovascular health (CVH) scores, incident cardiovascular disease (CVD), CVD death and all-cause mortality, examining differences by race/ethnicity. MethodsWe included men from Multi-Ethnic Study of Atherosclerosis (MESA), prospective cohort study which enrolled adults aged 45 to 84 years without known CVD at baseline. CVH was defined using the American Heart Association Life's Essential 8 (LE8) scores (0-100), excluding sleep (CVH score). ResultsIn this sample of 2,814 men, mean age at CVH assessment was 62.2 years, 82% were fathers, 24% self-identified as Black, 13% Chinese, 22% Hispanic, and 41% White. Fathers who were <20 and 20-24 years old at their oldest child's birth had worse overall CVH compared with fathers who were >35 years old (adjusted mean score 61.1 vs 64.7, p=0.01 and 61.0 vs 64.7, p<0.001 respectively). Fathers had worse overall CVH (adjusted mean score 63.2 vs 64.7, p=0.03) and more nicotine exposure (63.1 vs 66.6, p=0.04), than non-fathers. In age-adjusted models, fathers overall (hazard ratio [HR]=0.82; 95%CI, 0.69–0.98) and Black fathers (HR=0.73; 95%CI, 0.53–0.999) had a lower rate of all-cause mortality rate than non-fathers, but these associations were no longer significant in fully adjusted models. ConclusionFatherhood is a social determinant of health and understanding its influence may provide opportunities to improve men's health, particularly among men of color.

Prediction of mortality in young adults with cardiovascular disease using artificial intelligence

&lt;b&gt;Background:&lt;/b&gt; Young mortality is prevalent among patients with cardiovascular disease (CVD). To develop prediction models for CVD mortality in young adults, it is crucial to assess CVD risks. Early detection of cardiac disorders using machine learning algorithms, a branch of artificial intelligence (AI) is crucial for preventing more damage to coronary arteries and saving lives.&lt;br /&gt; &lt;b&gt;Aims:&lt;/b&gt; To predict mortality versus a life outcome among young adults (18-45 years) with CVD using AI technique known as Chi-squared automatic interaction detector (CHAID) algorithms.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; A large-scale dataset was extracted from the electronic health records of 809 young adult patients diagnosed with CVD using a retrospective design. Information was retrieved regarding young adults from Jordan who were admitted to public health institutions between 2015 and the end of 2021.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; CHAID algorithms were chosen among seven prediction models based on accuracy and area under curve to predict mortality vs life in young individuals (18-45 years old) with CVD. The mortality prediction algorithms started with pulse pressure, then diastolic blood pressure, then ischemic heart disease, and last geographical location.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; CHAID model used in our study indicated how the death rate was classified and distributed among a variety of parameters. As a result, we may argue that AI model could provide additional information on how many aspects are articulated in connection to CVD patient fatality situations.

Association of echocardiographic parameters with all-cause and cardiovascular mortality in patients with type 2 diabetes

BackgroundThis study aimed to evaluate associations between echocardiography markers and mortality in patients with type 2 diabetes mellitus (T2DM). MethodsDiabetes Care Management Program database of a medical center was used, including 5612 patients with T2DM aged 30 years and older and who underwent echocardiography assessment between 2001 and 2021. Cox proportional hazard regression models were used to evaluate associations of echocardiography abnormalities with all-cause and expanded cardiovascular disease (CVD) mortality. ResultsDuring a mean follow-up of 5.8 years, 1273 patients died. Hazard ratios (95% confidence intervals) of all-cause mortality for each standard deviation increase were presented for the cardiac systolic function indicator of left ventricular ejection fraction (0.77, 0.73–0.81), cardiac structural parameters of left ventricular mass index (1.25, 1.19–1.31) and left atrial volume index (1.31, 1.25–1.37), and cardiac diastolic function of E/A ratio (1.10, 1.07–1.13), E/e’ ratio (1.37, 1.30–1.45), and TR velocity (1.25, 1.18–1.32); meanwhile, the values of expanded CVD mortality included left ventricular ejection fraction (0.67, 0.62–0.72), left ventricular mass index (1.35, 1.25–1.45), left atrial volume index (1.40, 1.31–1.50), E/A ratio (1.12, 1.08–1.16), E/e’ ratio (1.57, 1.46–1.69), and TR velocity (1.29, 1.19–1.39), respectively. ConclusionsCardiac systolic function indicator of left ventricular ejection fraction, cardiac structural parameters of left ventricular mass index and left atrial volume index, and cardiac diastolic function indicators of E/A ratio, E/e’ ratio, and TR velocity are associated with all-cause and expanded CVD mortality in patients with T2DM.

Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

M&#257;ori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural M&#257;ori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-M&#257;ori and M&#257;ori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural M&#257;ori and other Indigenous Peoples in nations impacted by colonisation. The review was underpinned by Kaupapa M&#257;ori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

TRIM11 expression levels was downregulated and prevents ferroptosis of cardiomyocyte by Dusp6 in acute myocardial infarction.

Acute myocardial infarction (AMI) is the high incidence rate and mortality of common cardiovascular disease. Herein, we explored the critical role of TRIM11 in AMI and its underlying mechanism. Serum from patients with AMI were collected from our hospital. Mice of model group received angiotensin II. Mice of model + TRIM11 group received with Ang II and TRIM11 vectors. Mice of sham group received normal saline. H9c2 cells were performed transfections using Lipofectamine 2000 (Thermo Fisher Scientific Inc, Shanghai, China), and treated with Ang II. TRIM11 mRNA expression was reduced, was negative correlation with collagen I/III mRNA expression, systolic blood pressure, diastolic blood pressure, left anteroposterior atrial diameter, right atrial diameter, or left ventricular ejection fraction in patient with AMI. TRIM11 mRNA and protein expression were also suppressed. METTL3 regulates TRIM11 methylation to reduce TRIM11 gene stability in model of AMI. TRIM11 gene ameliorated AMI in mice model. TRIM11 gene reduced reactive oxygen species production level of cardiomyocyte in-vitro model. TRIM11 gene reduced ferroptosis of cardiomyocyte in-vitro model. TRIM11 gene reduced ferroptosis by the inhibition of mitochondrial damage of cardiomyocyte in model of AMI. TRIM11 induced Dusp6 protein expression. Bioluminescence imaging showed that TRIM11 virus increased Dusp6 expression in heart tissue of mice model. The inhibition of Dusp6 reduced the effects of TRIM11 on ferroptosis of cardiomyocyte in model of AMI. In conclusion, this study demonstrates that TRIM11 improves AMI by regulating Dusp6 to inhibit ferroptosis of cardiomyocyte, and suggest a novel target for AMI.

Associations of Relative Intensity of Physical Activity with Incident Cardiovascular Events and All-Cause Mortality.

The relative intensity of a physical activity (PA) can be estimated as the percent of one's maximal effort required. We compared associations of relative and absolute intensity PA with incident major cardiovascular disease (CVD) and all-cause mortality in 5,633 women from the Objective Physical Activity and Cardiovascular Health Study (mean age 78.5±6.7). Absolute intensity was measured by accelerometry. Relative intensity was estimated by dividing accelerometer-estimated metabolic equivalents (METs) by maximal MET capacity. Both were aggregated into mean daily hours of light intensity PA (LPA) and moderate-to-vigorous PA (MVPA). Cox proportional hazards models estimated hazard ratios (HRs) for one-hour higher amounts of PA on outcomes. During follow-up (median=7.4 years), there were 748 incident CVD events and 1,312 deaths. Greater LPA and MVPA, on either scale, was associated with reduced risk of both outcomes. HRs for a one-hour increment of absolute LPA were 0.88 (95% CI:0.83-0.93) and 0.88 (95% CI:0.84-0.92) for incident CVD and mortality, respectively. HRs for a one-hour increment of absolute MPVA were 0.73 (95% CI:0.61-0.87) and 0.55 (95% CI:0.48-0.64) for the same outcomes. HRs for a one-hour increment of relative LPA were 0.70 (95% CI:0.59-0.84) and 0.78 (95% CI:0.68-0.89) for incident CVD and mortality, respectively. HRs for a one-hour increment of relative MPVA were 0.89 (95% CI:0.83-0.96) and 0.82 (95% CI:0.77-0.87) for the same outcomes. On the relative scale, LPA was more strongly, inversely associated with both outcomes than relative MVPA. Absolute MVPA was more strongly inversely associated with the outcomes than relative MVPA. Findings support the continued shift in the PA intensity paradigm towards recommendation of more movement, regardless of intensity. Relative LPA--a modifiable, more easily achieved behavioral target, particularly among ambulatory older adults--was associated with reduced risk of incident major CVD and death.

Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis

Metabolic syndrome is linked to an increased risk of incident cardiovascular disease and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term cardiovascular disease risk. To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort. We studied 3367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy, and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from examinations 2 (2002-2004) to 6 (2016-2018). The mean age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy (hazard ratio, 1.32 [95% confidence interval, 1.01-1.73]) and hystero-oophorectomy (hazard ratio, 1.40 [95% confidence interval, 1.13-1.74]) were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy. Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomies and the mechanisms underpinning these associations may be explored.

Estimated pulse wave velocity predicts mortality in patients with heart failure with preserved ejection fraction

ObjectiveEstimated pulse wave velocity (ePWV), a newly established arterial stiffness (AS) parameter, predicts the development of cardiovascular disease (CVD) and death in the general population or in patients with CVD risk factors. However, whether ePWV is associated with adverse outcomes in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. Our study aimed to evaluate the prognostic value of ePWV on clinical outcomes in HFpEF. Methods and ResultsWe analyzed HFpEF participants from the Americas in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial with available baseline data (n = 1764). Cox proportional hazard model was used to explore the prognostic value of ePWV on long-term clinical outcomes (all-cause mortality, cardiovascular mortality, all-cause hospitalization, and heart failure hospitalization). Each ePWV increase by 1 m/s increased the risk for all-cause death by 16% (HR:1.16; 95% CI:1.10–1.23; P < 0.001) and CVD mortality by 13% (HR:1.13; 95% CI:1.04–1.21; P = 0.002) after adjusting for confounders. Patients were then grouped into 4 quartiles of ePWV. Our study indicated that the highest ePWV quartile (ePWV ≥ 12.806 m/s) was associated with increased risk of all-cause mortality (HR: 1.96; 95% CI: 1.43–2.69; P < 0.001) and CVD mortality (HR: 1.72; 95% CI: 1.16–2.56; P = 0.008) after adjusting for potential confounders. ConclusionThese results suggested ePWV is independently associated with increased all-cause mortality and CVD mortality in HFpEF patients, indicating ePWV is an appropriate predictor of prognosis in patients with HFpEF.

The Beverage Quality Index and risk of cardiometabolic outcomes after a myocardial infarction: A prospective analysis in the Alpha Omega Cohort

Background and aimsIndividual beverages have varying associations with cardiometabolic outcomes, but little is known about overall beverage quality and cardiometabolic risk after myocardial infarction (MI). We created the Beverage Quality Index (BQI) to assess beverage quality and examined its association with cardiometabolic outcomes after MI. Methods and resultsWe included 4365 Dutch post-MI patients from the Alpha Omega Cohort, aged 60–80 years. Diet was assessed at baseline (2002–2006) with a 203-item FFQ. The BQI included eight components (coffee, tea, milk, juices, sugar-sweetened beverages, alcohol, added sugar to coffee and tea, and energy from beverages), and ranged from 0 to 80. Multivariable Cox models were used to estimate HRs for the BQI in relation to incident diabetes mellitus (DM), major adverse cardiovascular events (MACE), recurrent cardiovascular disease (CVD) and fatal CVD over 3.4 y of follow-up, with follow-up for fatal CVD extended through 2018 (12.4 y). The average BQI was 50.0 ± 12.5. During 3.4 y of follow-up, we identified 186 incident cases of DM, 601 of MACE, 310 of recurrent CVD and 140 of fatal CVD. In multivariable models, a higher BQI (T3 vs. T1) was associated with lower risk of MACE [HR: 0.73 (0.59–0.90)], and recurrent CVD [HR: 0.67 (0.50–0.91)], but not with DM or CVD mortality. After 12.4 y of follow-up, 903 CVD deaths occurred. A significant inverse association with CVD mortality during long-term follow-up was found [HR: 0.81 (0.68–0.96)]. ConclusionOverall beverage intake quality, as assessed by the BQI, may represent an important target for the prevention of recurrent CVD.

Modeling the Impact of Biomarker-Guided Versus ASCVD Risk-Guided Drug Treatment in US Adults With Stage 1 Hypertension: The National Health and Nutrition Examination Survey, 1999 to 2004.

Guidelines recommend antihypertensive medication for adults with both stage 1 hypertension (systolic blood pressure, 130-139 mm Hg or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%. Cardiac biomarkers could facilitate a more targeted approach to the treatment of stage 1 hypertension. We studied 1999 to 2004 National Health and Nutrition Examination Survey participants aged ≥20 years with untreated stage 1 hypertension without heart failure or ASCVD. We measured hs-cTnI (high-sensitivity cardiac troponin I), hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in stored serum. We used the Pooled Cohort Equations to predict 10-year ASCVD risk. All participants had linked mortality follow-up through December 31, 2019. Overall, 17.5% of US adults (32.2 million) had untreated stage 1 hypertension. Among these 32.2 million persons, 15.7% had ASCVD risk ≥10%, 5.6% had elevated hs-cTnI, 4.7% had elevated hs-cTnT, and 9.5% had elevated NT-proBNP. Among adults aged 65 to 79 years with untreated stage 1 hypertension, 80.5% had ASCVD risk ≥10%, 13.0% had elevated hs-cTnI, 15.2% had elevated hs-cTnT, and 29.4% had elevated NT-proBNP. Less than half of the adults aged ≥80 years with untreated stage 1 hypertension had elevated biomarkers. The cardiovascular disease mortality rates among all adults with untreated stage 1 hypertension and with either ASCVD risk ≥10%, elevated hs-cTnI, elevated hs-cTnT, or elevated NT-proBNP were 7.51, 7.74, 8.75, and 5.87 per 1000 person-years, respectively. Cardiac biomarkers may be more selective for informing risk-based treatment decisions in stage 1 hypertension, particularly among adults aged ≥65 years.

PHYSICAL ACTIVITY IS ASSOCIATED WITH IMPROVED SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN THE UK BIOBANK

INTRODUCTION &amp; AIM Physical activity (PA) is known to be associated with a decreased risk of all-cause and cardiovascular mortality in apparently healthy adults. The association between PA and risk of death for individuals with prevalent cardiovascular disease (CVD) at baseline is less well understood. Therefore, the aim of this study was to determine the association between PA levels and survival in individuals with prevalent CVD at baseline. METHODS A survival analysis involving 38,291 UK Biobank participants with prevalent CVD at baseline was conducted. Physical activity was assessed using accelerometry-calibrated PA which measures total energy expended in PA. Prevalent CVD, all-cause mortality, and CVD mortality were determined through ICD-10 codes and data linkage through death and hospital records. Cox proportional hazard models were used to estimate the risk of all-cause, overall cardiovascular, and specific CVD category mortality for quartiles of PA after adjusting for known confounders. RESULTS There were 6,540 all-cause deaths and 3,559 cardiovascular deaths with median follow up time of 11.98 years. The risk of all-cause and overall cardiovascular mortality reduced with increasing dose of PA (highest vs lowest PA; HR = 0.70, 95% CI: 0.64 - 0.76 and 0.70, 95% CI: 0.62 - 0.79, respectively). Those in the highest quartile of PA had a 41% reduced risk of dying from cerebrovascular disease and a 38% reduced risk of dying from and hypertensive diseases (including hypertensive heart disease with heart failure). CONCLUSION Higher levels of PA are associated with lower risk of all-cause and overall cardiovascular mortality in individuals with prevalent CVD at baseline. These findings highlight the importance of PA in secondary prevention of cardiovascular disease.

Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study

Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings. Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity. During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction=0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction=0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality. The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities. R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).

ASSOCIATION OF BLOOD PRESSURE WITH MORTALITY IN OLDEST OLD PEOPLE WITH FRAILTY IN CHINA: RESULTS FROM CHINESE LONGITUDINAL HEALTHY LONGEVITY SURVEY (CLHLS)

Objective: To determine the target blood pressure in old people (80+ years) with frailty. Design and method: In this community based, longitudinal prospective study, we enrolled 3,134 oldest old people with frailty. The exposure-response associations between blood pressure and all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality were assessed by the penalized cubic splines fitted in Cox models. Results: During 5 years follow-up, 2,532 deaths were documented. An approximate L-shaped association between systolic blood pressure (SBP) and 5-year all-cause mortality was identified. Compared with 140 mmHg (inflection point), the risk of all-cause mortality significantly increased for SBP below 127 mmHg, which varied from HR of 1.050 (95% CI: 1.003-1.100) to 1.576 (95% CI: 1.128-2.203). After 140 mmHg, mortality risk gradually fell with increasing SBP, although not reaching statistical significance. Diastolic blood pressure (DBP) suggested a significant U-shaped association with 5-year all-cause mortality with 90 mmHg conferred the lowest risk. Before that, the risk of all-cause mortality rose with decreasing DBP, which varied from HR of 1.041 (95% CI: 1.001-1.082) to 1.304 (95% CI: 1.005-1.692). After 90 mmHg, although the observed differences were not statistically significant, mortality risk tended to rise with increasing DBP. Among the 2,037 participants with a confirmed cause of death, 346 died from CVDs and 1,691 died from non-CVDs. In comparison with 120 mmHg, SBP above 134 mm Hg exhibited a significantly elevated CVD mortality risk; when SBP below 121 mmHg, significantly increased non-CVD mortality risk could be found in comparison with SBP at 140 mmHg. As for DBP, it could not predict CVD mortality risk; there was an approximate U-shaped association between DBP and non-CVD mortality that DBP below 69 mmHg was associated with a higher risk with 85 mmHg as the reference. Stratified and sensitivity analyses showed robustness of main findings. Conclusions: In the oldest old people with frailty, in addition to all-cause mortality, blood pressure management should balance CVDs risk and non-CVD risk. Maintaining blood pressure at 120-140/80-100 mmHg can reduce all-cause mortality risk and meanwhile may prevent the adverse events due to excessively higher or lower blood pressure.

FMUPorto - Summaries and comments

A - Barriers and enablers influencing female athlete return-to-sport postpartum B - Occupational Sitting Time, Leisure Physical Activity, and All-Cause and Cardiovascular Disease Mortality

Associations Between Estimated Pulse Wave Velocity and Five-Year All-Cause Mortality in Patients with Atherosclerotic Cardiovascular Disease with and without Standard Modifiable Risk Factors: Evidence From NHANES 1999-2016.

The study aimed to analyze the associations between estimated pulse wave velocity (ePWV) and 5-year mortality in atherosclerotic cardiovascular disease (ASCVD) patients with and without standard modifiable risk factors (SMuRFs), which included smoking status, hypertension, diabetes, and hypercholesterolemia. The present retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Patients with ASCVD who completed both the questionnaire survey and serum testing were included. Patients were categorized into the ≥1 SMuRF group if they had at least one SMuRF, while those without any SMuRFs were classified into the SMuRF-less group. The ePWV, which was calculated using the age and mean blood pressure, was evenly divided into three categories: low (Q1), medium (Q2), and high (Q3). Multivariable weighted Cox proportional-hazard regression analyses were utilized to explore the risk factors associated with 5-year mortality in patients with and without SMuRFs. And restricted cubic spline curve (RCS) was used to assess their nonlinear correlation. A total of 1901 patients with ASCVD were included in the study. For the patients in ≥1 SMuRF group, the Q3 group included patients who were older, with a higher proportion of males, more comorbidities, and a lower body mass index than the Q1 group (P<0.05). The Cox proportional-hazard regression model results revealed, the Q3 group had a higher risk of 5-year mortality than the Q1 group [hazard ratio (HR) 4.30, 95% confidence interval (CI) (2.66, 6.95), P<0.001]. RCS demonstrated a linear trend between high level of ePWV and decreased risks of mortality. Similar results were observed in the SMuRF-less group [HR 10.62, 95% CI (1.22, 92.06), P=0.032]. A high level of ePWV signified a higher risk of 5-year mortality in ASCVD patients with and without SMuRFs.

Abstract 124: IRG1-Itaconate Axis Protects From Cholesterol-Induced Inflammation And Atherosclerosis

Atherosclerosis, the major underlying cause of cardiovascular disease (CVD) mortality, is fueled by a failure to resolve lipid-driven inflammation within the vessel wall. Understanding the immunometabolic mechanisms underpinning sustained inflammation within this microenvironment is needed for the development of novel targeted therapies. Immune responsive gene 1 (IRG) is an enzyme that diverts the TCA cycle intermediate, cis-aconitate, to produce itaconate, a metabolite with anti-microbial and anti-inflammatory functions. We used a translational approach to investigate the therapeutic potential of the Irg1-itaconate axis for human atherosclerosis. Using single cell RNA-sequencing, we found that IRG1 is upregulated in human coronary atherosclerotic lesions compared to patient-matched healthy vasculature, and is primarily expressed by plaque monocytes and macrophages. In mouse models of atherosclerosis, Irg1 was expressed by plaque monocytes, macrophage and neutrophils, but declined with disease progression. Global or hematopoietic Irg1 -deficiency increased atherosclerosis burden, plaque lipid content, and expression of interleukin (IL)-1b. Mechanistically, absence of Irg1 potentiates lipid accumulation and lipid-mediated inflammation via a feed-forward cycle involving increased neutrophil extracellular trap (NET) formation, NET-induced NLRP3 inflammasome priming in macrophages, and subsequent IL-1b release. Conversely, supplementation of the Irg1 pathway using the derivative 4-octyl itaconate (4-OI) reduced atherosclerotic inflammation and promoted beneficial plaque remodeling in mice. To assess the therapeutic potential of 4-OI in humans, we leveraged a validated systems-immunology approach to investigate CVD-related inflammation ex vivo . Using high dimensional single cell analyses, we showed that 4-OI supplementation attenuated pro-inflammatory phospho-signaling in human peripheral blood mononuclear cells treated with plasma from CVD patients, and caused an anti-inflammatory rewiring of macrophage populations. Our data highlight the relevance of pursuing Irg1 -itaconate axis supplementation as a therapeutic approach to treat atherosclerosis in humans.