Cardiovascular Disease In Population Research Articles

Cultural factors influencing self-care by persons with cardiovascular disease: An integrative review

BackgroundSelf-care is critical for maintaining health, minimizing disease complications, and improving quality of life. Understanding valid, culturally-specific practices and their influence on self-care behaviors can inform development of interventions to improve outcomes for individuals living with cardiovascular disease (CVD). To date, the influence of culture on self-care behaviors has not been adequately examined in different CVD populations. AimThe aim of this review was to synthesize past empirical literature examining cultural factors influencing self-care in patients with CVD. MethodAn integrative review method was used. A literature search was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus, and the International Bibliography of the Social Sciences (IBBS) computerized databases. No limit was placed on publication date. Articles were included if they were: (1) peer-reviewed original primary research studies, (2) published in English with full-text availability, (3) conducted in adults (≥19 years), (4) addressed culture related to health and health behaviors, (5) related to self-care or elements of self-care, and (6) related to CVD. Fourteen articles met the inclusion criteria and were included in this review. ResultsCulture influences self-care in general, but predominantly self-care maintenance behaviors. In African American and South Asian populations, cultural beliefs such as fatalism, collectivism and traditional gender roles clashed with dietary adherence. Traditional beliefs and ideas, collectivism, family and kinship ties, fatalism, cultural norms and normative thinking played critical roles in medication adherence and use of complementary/alternative medicine. Similarly, cultural beliefs and social norms influenced how individuals interpreted and responded to their symptoms. ConclusionThe findings shed light on the importance of understanding cultural factors that help or hinder self-care behaviors among individuals with CVD. Understanding such influences is anticipated to facilitate the design of effective, tailored interventions.

PERCENTILE DISTRIBUTION OF CAROTID INTIMA-MEDIA THICKNESS IN THE GENERAL WORKING-AGE POPULATION

Objective.To study the gender- and age-specific percentile distribution of carotid intima-media thickness (cIMT) in the unorganized urban working-age population.Material and Methods. Presented data were obtained in the ESSE-RF study in the city of Tomsk (1,412 participants, 25–64 years old without cardiovascular diseases, 59% women). All the surveyed signed voluntary informed consent form to participate in the study. We studied distributions of the mean and maximum cIMT obtained by the automatic and manual measurements, respectively. An error probability of less than 5% was considered statistically significant.Results. Both indicators of cIMT consistently increased with age in both gender groups. Maximum cIMT (max-cIMT) increased stronger than the mean cIMT (mean-cIMT). Compared with data obtained in other studies, the mean-cIMT estimates were distributed closer to the upper pole of the spectrum presented and increased stronger in 35–55-year-old men compared with those in the populations of Central and Southwestern Europe; the mean-cIMT estimates showed the most pronounced gender effect. Similar trends were identified in relation to the max-cIMT distribution.Conclusion. Obtained data allowed for specific assessment of the individual cIMT values by gender and age within the framework of risk stratification among people of working age without cardiovascular diseases. Further studies aimed at clarifying the prognostic role of high cIMT values in general population, taking into account the influence of traditional and new cardiovascular risk factors, can broaden the understanding of the significance of vascular state assessment as one of the key points, linking risk factors to clinical events, for primary prevention of cardiovascular diseases in population.

PERCENTILE DISTRIBUTION OF CAROTID INTIMA-MEDIA THICKNESS IN THE GENERAL WORKING-AGE POPULATION

Objective.To study the gender- and age-specific percentile distribution of carotid intima-media thickness (cIMT) in the unorganized urban working-age population.Material and Methods. Presented data were obtained in the ESSE-RF study in the city of Tomsk (1,412 participants, 25–64 years old without cardiovascular diseases, 59% women). All the surveyed signed voluntary informed consent form to participate in the study. We studied distributions of the mean and maximum cIMT obtained by the automatic and manual measurements, respectively. An error probability of less than 5% was considered statistically significant.Results. Both indicators of cIMT consistently increased with age in both gender groups. Maximum cIMT (max-cIMT) increased stronger than the mean cIMT (mean-cIMT). Compared with data obtained in other studies, the mean-cIMT estimates were distributed closer to the upper pole of the spectrum presented and increased stronger in 35–55-year-old men compared with those in the populations of Central and Southwestern Europe; the mean-cIMT estimates showed the most pronounced gender effect. Similar trends were identified in relation to the max-cIMT distribution.Conclusion. Obtained data allowed for specific assessment of the individual cIMT values by gender and age within the framework of risk stratification among people of working age without cardiovascular diseases. Further studies aimed at clarifying the prognostic role of high cIMT values in general population, taking into account the influence of traditional and new cardiovascular risk factors, can broaden the understanding of the significance of vascular state assessment as one of the key points, linking risk factors to clinical events, for primary prevention of cardiovascular diseases in population.

Future projection of cancer patients with cardiovascular disease in Japan by the year 2039: a pilot study

BackgroundThe number of cancer patients in Japan is estimated to rise to 3.5 million by 2025. The disease burden may be further complicated by comorbidities caused by cardiovascular disease (CVD). Predicting the number of cancer patients with CVD can help anticipate future resource needs.MethodsWe used statistics derived from the Niigata Cancer Center CVD Study (2015) as well as population estimates from the National Cancer Center’s Cancer Registry and Statistics survey of 2017 for convenience. We simply multiplied the projected number of cancer patients through the year 2039 by the CVD prevalence in 2015, with patients classified by sex, age, and cancer type to estimate the number of cancer patients with CVD.ResultsThe total number of Japanese cancer patients with CVD was 253,000 in 2015 and is predicted to increase rapidly by 30,000 in 2020 and peak at 313,000 in 2030–2034. Men will dominate the CVD population at 2.5-fold the number of women. The growth rate of the population with both cancer and CVD will be greater than that of the cancer-only population (1.23 vs 1.18, P < 0.001), and will comprise notably high proportions of patients with prostatic, breast, and uterine cancers (1.80, 1.57, and 1.66, P < 0.001, respectively).ConclusionFuture cancer patients will be older and more likely to have CVD. Although men will continue to dominate this population, the increase in the number of women will be pronounced. Cancer care providers should be trained to recognize CVD and provide any necessary interventions concurrently with cancer therapy.

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis.

Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of type 2 diabetes mellitus. Recently, a series of studies has suggested that women with GDM also have an increased risk of cardiovascular disease (CVD). However, it is unclear if this risk is dependent upon the intercurrent development of type 2 diabetes. Thus, we conducted a systematic review and meta-analysis to evaluate the impact of GDM on future risk of incident CVD and to ascertain the role of type 2 diabetes in this regard. We systematically searched the PubMed and EMBASE databases for observational studies that evaluated the association of GDM with subsequent CVD, with publication between 1 January 1950 and 30 August 2018. Two independent reviewers extracted data and the analysis was performed in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. RRs were calculated using a random-effects model to assess the predictive value of GDM for future cardiovascular events. To evaluate whether incident type 2 diabetes in the GDM population influenced the association with CVD, we used meta-regression models followed by sensitivity analyses restricted to women who did not develop type 2 diabetes during follow-up. A pooled analysis of nine studies yielded data from 5,390,591 women (101,424 cardiovascular events). Compared with those who did not have GDM, women with GDM had a twofold higher risk of future cardiovascular events (RR 1.98 [95% CI 1.57, 2.50]). Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk (p = 0.34). Moreover, when restricted to women who did not develop type 2 diabetes, GDM remained associated with a 56% higher risk of future cardiovascular events (RR 1.56 [95% CI 1.04, 2.32]). GDM conferred a 2.3-fold increased risk of cardiovascular events in the first decade postpartum (RR 2.31 [95% CI 1.57, 3.39]). The diagnosis of GDM identifies young women who have a twofold higher risk of cardiovascular events postpartum compared with their peers. This risk is not dependent upon intercurrent type 2 diabetes and is apparent within the first decade after pregnancy. Thus, even without progressing to type 2 diabetes, women with GDM comprise an at-risk population for CVD and hence a potential opportunity for early risk factor surveillance and risk modification.

Measurement of health literacy in patients with cardiovascular diseases: A systematic review.

While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.

The higher serum endocan levels may be a risk factor for the onset of cardiovascular disease: A meta-analysis.

Objective:Endothelial dysfunction was widely regarded as the initial lesion in the multifactorial pathogenesis of cardiovascular disease (CVD). Serum endocan, a novel endothelial dysfunction biochemical marker, is involved in the development of CVD. Here, we fulfilled a meta-analysis to evaluate the association between CVD and serum endocan levels.Method:The relevant published literature was searched through large literature databases, including PubMed, Embase, Cochrane Library, SinoMed, and Web of Science, up to June 1, 2018. The data were extracted from the studies. Stata software was used to perform a meta-analysis.Result:Fifteen original studies with a total of 1839 patients and 1258 controls fulfilled the inclusion criteria and were included in the study dataset. Meta-analysis showed that the levels of serum endocan in patients with hypertension, coronary artery disease, and coronary slow flow were higher than those in the control group. The pooled standardized mean differences and 95% confidence intervals of endocan concentrations in those 3 groups were 0.53 [0.19–0.86], P < .01; 0.99 [0.51–1.39], P < .01; and 0.62 [0.45–0.78], P < .01, respectively. Further analysis showed that the level of serum endocan in hypertension patients with coronary artery disease was higher than that in patients with hypertension (0.61 [0.30–0.92], P < .01). Sensitivity analysis and subgroup analysis were use to confirm the above results.Conclusions:In this meta-analysis, we further confirmed that serum endocan level was significantly increased in the CVD population. The high serum endocan level may be one of the risk factors for CVD.

Persistent Underrepresentation of Kidney Disease in Randomized, Controlled Trials of Cardiovascular Disease in the Contemporary Era.

Over the last few decades, studies have consistently demonstrated an increased risk of ischemic heart disease, heart failure, and arrhythmias in patients with kidney disease (KD).[1][1] The presence of KD also confers significantly greater risk for poor outcomes in patients with cardiovascular

Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation).

Posttransplantation diabetes mellitus (PTDM) increases the risk of cardiovascular disease, graft loss, and decreased survival. Follow-up treatment after solid organ transplantation (SOT) needs to focus on, inter alia, maintaining balanced glucose metabolism. This study aimed to ascertain the prevalence of PTDM and describe patient characteristics in the large DPV (Diabetes Patienten Verlaufsdokumentation) pediatric diabetes database. DPV data of 71 902 patients from the January 01, 1995 to January 04, 2015 period were analyzed for patients with and without cystic fibrosis (CF) after SOT (kidney, liver, heart, and lung). Multivariable analysis served to assess differences between SOT patient groups at risk for developing diabetes. Out of 109 SOT patients, 51 had CF; 72.5% received steroids and 62% were additionally given tacrolimus. PTDM developed in 45% of CF patients and 12% of non-CF patients. SOT patients were older at diabetes onset (mean age, 12.50 ± 3.98 years), shorter (height z-score, -1.67 ± 1.25), and lighter (weight z-score, -1.59 ± 1.57) than non-SOT diabetes patients (P < 0.01). With transplantation, glycated hemoglobin (HbA1c) was significantly lower and treatment for hypertension and dyslipidemia was increased. Among SOT patients, weight and body mass index (BMI) z-scores were significantly lower in patients with CF-related diabetes (P < 0.05). SOT was present in 6.6% of children with diabetes, and this might aggravate the risk of cardiovascular disease in populations with already increased rates of hypertension and dyslipidemia. Dystrophy and short stature were also present, particularly in transplant recipients with CF and diabetes. Comorbidities and long-term consequences call for multidisciplinary collaboration.

Chronic Kidney Disease (CKD) in U.S. Adults with Self-Reported Cardiovascular Disease (CVD)—A National Estimate of Prevalence by KDIGO 2012 Classification

Overall prevalence of CKD in the U.S. adult general population was estimated to be 14.8%. But data on the prevalence of CKD among CVD population are limited. Using the NHANES 2007-2014 data, we conducted a cross-sectional analysis of an adult sample with self-reported CVD (n=2325), aged ≥18 years, to assess prevalence of CKD in U.S. adults with CVD using KDIGO 2012 classification. Participants with CVD were identified based on self-reported personal interview data on a broad range of health conditions—congestive heart failure, coronary heart disease, angina, stroke, or heart attack. Appropriate sample weights were used to provide a national estimate. Results of prevalence of CKD in U.S. adults with self-reported CVD are presented in Table 1. The prevalence of moderately to severely decreased renal impairment based on eGFR below 60 ml/min/1.73m2 was 24.9%: 14.1% with Stage 3a, 7.8% with Stage 3b, and 3.0% with Stage 4 or 5. The prevalence of mildly decreased renal impairment (stage 2, eGFR=60-90 ml/min/1.73m2) was 45.2%: 36.8% with UACR&amp;lt;30 mg/g (normal to mildly increased albuminuria), 7.4% with UACR≥ 30-300 mg/g (moderately increased albuminuria) and 1.1% with UACR &amp;gt;300mg/g (severely increased albuminuria). This study confirms the high prevalence of CKD in CVD, and provides insights into distribution by CKD categories based on the KDIGO 2012 classification. Disclosure T. Wang: Employee; Self; Merck &amp; Co., Inc.. Stock/Shareholder; Self; Merck &amp; Co., Inc.. Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc.. Y. Xi: None. R.N. Lubwama: None. C. Koro: Employee; Self; Merck &amp; Co., Inc.. Stock/Shareholder; Self; GlaxoSmithKline plc..

The Prevalence of Patients At Very High Risk For Cardiovascular Events In The United Kingdom

The primary objective was to estimate the prevalence of patients at very high risk of cardiovascular events in the United Kingdom. This was a cross-sectional study using the Clinical Practice Research Datalink (CPRD). We included patients age ≥18 in 2013 with treated hypercholesterolemia (≥2 prescriptions for lipid modifying therapy [LMT]). We defined two very high risk populations based on 2016 European Society of Cardiology guidelines: documented cardiovascular disease (CVD) and type 2 diabetes without documented CVD (DM2w/oCVD). CVD included acute coronary syndrome ([ACS]: myocardial infarction, unstable angina, revascularization, stable angina, or cardiac ischemia), ischemic stroke ([IS] also included transient ischemic attack or carotid stenosis), and peripheral arterial disease ([PAD] also included abdominal aortic aneurysm). In 2013, 9.4% of all CPRD patients (504,907) received LMT (>95% received statins) and 4.8% were at very high risk for CVD (2.8% CVD and 2% DM2w/oCVD). In the CVD population, 73% had ACS, 18% had IS, and 9% had PAD. The ACS subgroup included 35% with myocardial infarction and 65% with stable or unstable angina, revascularization, or cardiac ischemia; in the IS subgroup 31% of patients had ischemic stroke and 69% had carotid stenosis; and the PAD subgroup included 93% with PAD and 7% with abdominal aortic aneurysm. In the overall CVD population, 25% had type 2 diabetes, 25% had recurrent CVD, and 7% had both. In the CVD and DM2w/oCVD populations, 24% and 14% respectively received a high-intensity statin or statin with ezetimibe. A substantial proportion of the CVD population had LDL-cholesterol levels above commonly suggested thresholds: 24% above 2.6 mmol/L (100 mg/dL) and 62% above 1.8 mmol/L (70 mg/dL). In the DM2w/oCVD population the respective proportions were 23% and 59%. Our analysis shows the need for additional intensive LDL lowering in well-defined populations at very high risk for cardiovascular events.

Pathophysiology and treatment of cardiovascular disease in pediatric chronic kidney disease.

Life expectancy in patients with all stages of chronic kidney disease (CKD) falls far short of that in the general population. Cardiovascular disease is the leading cause of mortality in pediatric patients with CKD. In contrast to the intimal atherosclerotic lesions that characterize cardiovascular disease in the general population, vascular endothelial dysfunction, medial arterial calcification, and cardiac dysfunction contribute to cardiovascular pathological conditions in CKD. The pathogenesis of these lesions, the origins of which can be identified in the absence of traditional cardiovascular risk factors, is incompletely understood. CKD-mediated vascular calcification in CKD is characterized by a transition of vascular smooth muscle cells to an osteoblast-like phenotype and altered bone and mineral metabolism are strongly linked to progressive cardiovascular disease in this population. Renal osteodystrophy therapies, including phosphate binders, vitamin D analogs, and calcimimetics, have an impact on the progression of cardiovascular disease. However, cardiovascular disease has its origins before the development of secondary hyperparathyroidism, and optimal therapeutic regimens that minimize cardiac dysfunction, vascular calcification, and early mortality remain to be defined.

The comparison of insulin levels between over weighted and non-obese smokers

Cardiovasculer diseases are the most common reason for morbidity and mortality in the world. Smoking and obesity are among the most important avoidable reasons for these diseases. However, in Turkey, there are not enough studies about the effect of obesity (central and androgenic) on insulin levels of smokers. With this aim; oral glucose tolerance test (OGTT) was performed on 84 patients who meet the study criteria among 211 patients treated at the second internal diseases clinic of Taksim Hospital between November 1997 and May 1998, who were volunteers, smokers and older than 18. In addition, the total cholesterol, HDL, LDL and triglicerid levels of these patiens were checked. Heights, weights and waist circumferences of patients were measured. From these datas, body mass indexes (BMI) and waist circumferences (WC) were calculated. Nicotine addiction levels of patients were evaluated by Fagerstrom Nicotine Dependency Test (FNDT) and package/year amounts were calculated. According to the results based on the data obtained from the studies, no difference were determined (p>0.05), in ages, FNDT scores, insulin, TC, LDL and HDL levels between overweighted and normal weighted patients. On the other hand; there was statistically significant difference between two groups in BMI values, WC measurements (between different genders) and TG levels. In the regression analysis; BMI [OR: 1.512, (95% CI min=0.928, max=2.069)] and WC [OR: 1.912, (95% CI min=1.051, max=2.125)] was founded as a risk factor for the insulin increment. Additional information about the subject for the large participation cross-sectional studies. More action about life style modification (smoking cessation and an effective weight control) may increase risk of cardiovascular diseases in populations.

The development of a method to determine the burden of climate change on different health outcomes at a local scale: a case study in Osaka Prefecture, Japan

Climate change impacts human health in a variety of ways. Variables including the climate-related risk factor, the health outcome and location all determine the nature and extent of the impact. The existence of different pathways and endpoints presents a problem for quantifying and comparing impacts. Disability-adjusted life year (DALY) provides a common scale, whereby the impact of climate change on both acute and chronic health outcomes can be compared. This study presents a methodology to calculate the impact of climate change on human health at a local scale, using cardiovascular disease (CVD) and meteorological disaster-related injuries (DRIs) in Osaka Prefecture, Japan, as applied case studies. An additional very fine scale assessment of CVD conducted at the neighbourhood level to demonstrate the importance of conducting risk assessments at a local level. The comparative results calculated the impact of climate change in 2050 to be 16.866 DALY/100,000 population for CVD and 0.645 DALY/100,000 for meteorological DRIs. The actual impact of climate change by 2050 on CVD is judged to be higher, although the relative risk was projected to be lower (1.006, compared to 1.263 for meteorological DRIs). The fine scale assessment revealed the variations in the projected impact of climate change on CVD for all administrative zones in Osaka Prefecture. The range of impacts varied from 0 to 114.29 DALY/100,000. The results demonstrate the applicability of using DALY to quantify the impact of climate change on different health outcomes, using a transferable methodology, and provide information that enables evidence-based prioritisation of climate change adaptation strategies at a local scale.

Nutritional status and risk factor for cardiovascular diseases in population of preschool children aged 4 years

Healthy nutrition in childhood is of major importance for maintenance of health in adults. Early detection of nutritional status impairments in children is directed toward prevention of chronic non-contageous diseases. Obesity in children is reported as the most important public health problem in pediatrics in developed countries. The aim of this study was to established the frequency of overweight and obesity, as well as blood pressure levels in population of 4-years aged children. This study enrolled 125 children aged 4 years. The survey was conducted during their regular systematic exams. Nutritional status was estimated from standard antrhropometric measurements. Data regarding nutritional habits, as well as physical activity were collected from parents, using questionnaire. 67,2% of children were normally nourished, 19,2% were overweight, 10,4% were obese, and 3.2% undernourished. Average values of body weight on birth were similar, regardless of nutritional status and gender, as well as actual BMIs o parents. Sedentary activities were the most frequent in overweight children of both gender, which is statistically significant when compared to normally nourished (2,61 ▫ 1,36 h vs 1,91 ▫ 0,98 h; p<0,05 for boys; 2,75 ▫ 0,96 h vs 1,89 ▫ 0,80 h; p<0,05 for girls). Significantly higher values of blood pressure were recorded in obese boys compared to normally nourished (systolic BP: 101,25 ▫ 6,41 mm Hg, vs 96,36 ▫ 4,86; p<0,05; dyastolic BP: 71,25 ▫ 6,41 mm Hg, vs 66,14 ▫ 4,81; p<0,05). Obese girls had significantly higher systolic BP compared to normally nourished: 103,33 ▫ 5,77 mm Hg, vs 97,03 ▫ 5,19; p<0,05. Obtained results indicate the relationship between obesity and higher blood pressure even in such young children, which is the major contribution of this study, considering the lack of investigations in similar populations, as well as the previously established fact that increased risk in childhood may predict the development of cardiovasculard diseases in adult life.

ATP2B1 gene Silencing Increases Insulin Sensitivity through Facilitating Akt Activation via the Ca2+/calmodulin Signaling Pathway and Ca2+-associated eNOS Activation in Endothelial Cells.

Endothelial cell insulin resistance may be partially responsible for the higher risk of atherosclerosis and cardiovascular disease in populations with insulin resistance and type 2 diabetes mellitus (T2DM). A genome-wide association study revealed a significant association between the ATPase plasma membrane Ca2+ transporting 1 (ATP2B1) gene and T2DM in two community-based cohorts from the Korea Association Resource Project. However, little is known about the implication of the ATP2B1 gene on T2DM. In the present study, we investigated the role of the ATP2B1 gene in endothelial cell insulin sensitivity. ATP2B1 gene silencing resulted in enhanced intracellular calcium concentrations and increased insulin-induced Akt activation compared to that in the negative siRNA-transfected HUVECs (Human Umbilical Vein Endothelial Cells). The elevated insulin sensitivity mediated by ATP2B1 gene silencing was Ca2+/calmodulin-dependent, as verified by administration of the calcium chelator BAPTA-AM or the calmodulin-specific antagonist W7. Moreover, higher levels of phosphorylation of eNOS (Ser1177) were observed in ATP2B1-silenced HUVECs. In addition to BAPTA-AM and W7, L-NAME, an eNOS antagonist, abolished insulin-induced Akt phosphorylation at Ser473 in both si-Neg and si-ATP2B1-transfected endothelial cells. These results indicate that the enhanced insulin sensitivity in ATP2B1-silenced endothelial cells is alternatively dependent on an increase in intracellular Ca2+ and the subsequent activation of the Ca2+/calmodulin/eNOS/Akt signaling pathway. In summary, ATP2B1 gene silencing increased insulin sensitivity in endothelial cells by directly modulating the Ca2+/calmodulin signaling pathway and via the Ca2+/calmodulin/eNOS/Akt signaling pathway alternatively.

Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study.

Cadmium is an environmental pollutant that has been associated with cardiovascular disease in populations, but the relationship of cadmium with hypertension has been inconsistent. We studied the association between urinary cadmium concentrations, a measure of total body burden, and blood pressure in American Indians, a U.S. population with above national average cadmium burden. Urinary cadmium (Cd) was measured using inductively coupled plasma mass spectrometry, and adjusted for urinary creatinine concentration. Among 3,714 middle-aged American Indian participants of the Strong Heart Study (mean age 56 years, 41% male, 67% ever-smokers, 23% taking anti-hypertensive medications), urinary Cd ranged from 0.01 to 78.48 μg/g creatinine (geometric mean=0.94 μg/g) and it was correlated with smoking pack-year among ever-smokers (r2=0.16, P<0.0001). Participants who were smokers were on average light smokers (mean 10.8 pack-years), and urinary Cd was similarly elevated in light- and never-smokers (geometric means of 0.88 μg/g creatinine for both categories). Log-transformed urinary Cd was significantly associated with higher systolic blood pressure in models adjusted for age, sex, geographic area, body mass index, smoking (ever vs. never, and cumulative pack-years) and kidney function (mean blood pressure difference by lnCd concentration [β]=1.64, P=0.002). These associations were present among light- and never-smokers (β=2.03, P=0.002, n=2,627), although not significant among never-smokers (β=1.22, P=0.18, n=1,260). Cd was also associated with diastolic blood pressure among light- and never-smokers (β=0.94, P=0.004). These findings suggest there is a relationship between cadmium body burden and increased blood pressure in American Indians, a population with increased cardiovascular disease risk.

HDL Cholesterol Efflux Does Not Predict Cardiovascular Risk in Hemodialysis Patients

The cardioprotective effect of HDL is thought to be largely determined by its cholesterol efflux capacity, which was shown to inversely correlate with atherosclerotic cardiovascular disease in populations with normal kidney function. Patients with ESRD suffer an exceptionally high cardiovascular risk not fully explained by traditional risk factors. Here, in a post hoc analysis in 1147 patients with type 2 diabetes mellitus on hemodialysis who participated in the German Diabetes Dialysis Study (4D Study), we investigated whether the HDL cholesterol efflux capacity is predictive for cardiovascular risk. Efflux capacity was quantified by incubating human macrophage foam cells with apoB-depleted serum. During a median follow-up of 4.1 years, 423 patients reached the combined primary end point (composite of cardiac death, nonfatal myocardial infarction, and stroke), 410 patients experienced cardiac events, and 561 patients died. Notably, in Cox regression analyses, we found no association of efflux capacity with the combined primary end point (hazard ratio [HR], 0.96; 95% confidence interval [95% CI], 0.88 to 1.06; P=0.42), cardiac events (HR, 0.92; 95% CI, 0.83 to 1.02; P=0.11), or all-cause mortality (HR, 0.96; 95% CI, 0.88 to 1.05; P=0.39). In conclusion, HDL cholesterol efflux capacity is not a prognostic cardiovascular risk marker in this cohort of patients with diabetes on hemodialysis.

Cardiac Abnormalities in Youth with Obesity and Type 2 Diabetes

Childhood obesity has been linked to cardiovascular disease (CVD) risk in adulthood. Of great concern is the expected increase in the population's CVD burden in relation to childhood obesity. This is compounded by the risk related to chronic hyperglycemia exposure in youth with type 2 diabetes. We herein provide an overview of the spectrum of early cardiovascular disease manifestation in youth with obesity and type 2 diabetes, in particular abnormalities in cardiac structure and function. Cardiac remodeling and adverse target organ damage is already evident in the pediatric age group in children with obesity and type 2 diabetes. This supports the importance of intensifying obesity prevention efforts and early intervention to treat comorbidities of obesity in the pediatric age group to prevent cardiac events in early adulthood.

Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China.

BackgroundLifestyle and dietary changes reflect an ongoing epidemiological transition in China, with cardiovascular disease (CVD) playing an ever-increasing role in China’s disease burden. This study assessed the burden of CVD and the potential value of lipid and blood pressure control strategies in China.MethodsWe estimated the likely burden of CVD between 2016 and 2030 and how expanded use of lipid lowering and blood pressure control medication would impact that burden in the next 15 years. Accounting for the costs of drug use, we assessed the net social value of a policy that expands the utilization of lipid and blood pressure lowering therapies in China.ResultsRises in prevalence of CVD risk and population aging would likely increase the incidence of acute myocardial infarctions (AMIs) by 75 million and strokes by 118 million, while the number of CVD deaths would rise by 39 million in total between 2016 and 2030. Universal treatment of hypertension and dyslipidemia patients with lipid and blood pressure lowering therapies could avert between 10 and 20 million AMIs, between 8 and 30 million strokes, and between 3 and 10 million CVD deaths during the 2016–2030 period, producing a positive social value net of health care costs as high as $932 billion.ConclusionsIn light of its aging population and epidemiological transition, China faces near-certain increases in CVD morbidity and mortality. Preventative measures such as effective lipid and blood pressure management may reduce CVD burden substantially and provide large social value. While the Chinese government is implementing more systematic approaches to health care delivery, prevention of CVD should be high on the agenda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1420-8) contains supplementary material, which is available to authorized users.