Cardiovascular Risk Factors In Persons Research Articles

Кардиоваскулярная и метаболическая коморбидность при ревматических заболеваниях: фокус на гиперурикемию и подагру

Cardiovascular and metabolic comorbidities in patients with rheumatic diseases (RD) determine the risk of adverse outcomes. Gout is one of the diseases which significantly increase the cardiovascular risk (CVR). The authors present a literature review elucidating the prevalence and spectrum of cardiovascular (CVD) and metabolic diseases, as well as the proven CVR factors in persons with RDs, including gout. As demonstrated, the increased CVR amid RDs is caused not only by a higher prevalence of the traditional CVR factors but is also related to multiple specific disease-associated risk factors. Chronic systemic inflammation, the development of internal organ lesions and the long-term use of anti-inflammatory therapy contribute negatively to the overall CVR. Thus, RDs are considered as important CVR re-classifiers and require a compulsory revision of the risk factors. Currently, the national and international guidelines for the CVR prevention in persons with RD have been developed and used in practice. Among RDs, a special place is held by gout which is characterized by common cardiovascular comorbidities and reduced glomerular filtration rate. The recent studies have demonstrated that in the management of patients with hyperuricemia (HU) and gout it is necessary to achieve a sustained target level of uric acid for preventing adverse effects on the organ systems and reducing CVR. Among the recommended therapeutic options for patients with cardiovascular and renal comorbidities, the preference is given to febuxostat, a urate-lowering drug with high activity and proven safety. KEYWORDS: comorbidities, rheumatic diseases, gout, cardiovascular risk, febuxostat. FOR CITATION: Babaeva A.R., Kalinina E.V., Zvonorenko M.S. et al. Cardiovascular and metabolic comorbidities associated with rheumatic diseases: focus on hyperuricemia and gout. Russian Medical Inquiry. 2023;7(3):150–159 (in Russ.). DOI: 10.32364/2587- 6821-2023-7-3-150-159.

Cardiovascular risk factors in a healthy population in the Croatian centre for cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction According to the statistics of the WHO, cardiovascular diseases (CVD) are the leading cause of death. The problem of CVD is the fact that they do not give the right symptoms, and often lead to personal or public health problems. The first signs of CVD may be an acute myocardial infarction (AMI) or cerebrovascular insult (CVI) and it is important that the cause of them is a combination of risk factors (RF) that we can influence. High cardiovascular risk, due to the presence of one or more RF, requires early intervention with the aim of timely prevention of possible new complications. Purpose The aim of the retrospective study was to determine the prevalence of cardiovascular RF in persons who underwent preventive examinations at our Clinic for Treatment, Prevention and Rehabilitation of CVD. Methods The study included 100 respondents aged between 30 and 60y. When collecting and presenting data, the privacy and identity of the respondents are protected. For the purposes of the research, the data of medical documentation were used. The parameters used for the study were age, sex, height, weight, body mass index, abdominal thickness, arterial pressure values, blood sugar, ergometric and spirometry findings. For each respondent, daily life habits such as alcohol and smoking consumption, and levels of physical activity were recorded. Microsoft Excel and Statistics are used for data processing. Results According to the analysis of the obtained data, an equal number of men and women participated in the research (average age 47y). Anthropometric testing yielded a mean BMI for men and women which tells us that 44% of respondents are overweight and 21% are obese. Prior to the examination, 20% of respondents were diagnosed with arterial hypertension (AH), arrhythmia, hyperlipoproteinemia and diabetes. Only 2% of the subjects had elevated blood glucose values. Spirometric findings in all subjects were correct, while ergometric testing showed a decrease in values in as many as 75% of subjects. The control of daily living habits determined the enjoyment of tobacco products in 32% and alcohol in 10% of respondents. A worrying fact is that only 5% of respondents engage in some physical activity. In addition, new diagnoses are hyperlipoproteinemia IIa (40%), hyperlipoproteinemia IIb (16%), AH (13%), hyperlipidemia (6%), arrhythmia (4%), diabetes (2%), triglyceridemia (2%), ischemic heart disease (1%), carotid artery stenosis (1%). Conclusions The study found an increased incidence of cardiovascular RF in people who are not older. New diagnoses suggest a change in life habits towards eliminating the present cardiovascular RF in order to prevent possible cardiovascular incidents. It is through this organized, systematic and regular prevention that cardiovascular diseases are reduced to a significant level.

Cardiovascular risk factors in pediatric kidney transplant recipients

Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiovascular disease remains one of the most common causes of death in children and young adults. The authors performed a comprehensive analysis of cardiovascular risk factors before and after kidney transplantation. Methods: Retrospective study, from 2007 to 2017, that included children and adolescents with a minimum of six months follow -up after kidney transplant. Demographic profile, chronic kidney disease characteristics and family and personal cardiovascular risk factors (hypertension, left ventricular hypertrophy, anemia, overweight/obesity, dyslipidemia, hypoalbuminemia and new onset diabetes after transplant) were assessed. Pre - and post -transplant cardiovascular risk factors were compared using the McNemar test. Results: We included 49 patients, with a mean age at the time of transplantation of 9.3 ± 4.2 years. Congenital anomalies of kidney and urinary tract (37.7%) and glomerulopathies (32.7%) were the most frequent causes of stage 5 chronic kidney disease. Transplantation was preemptive in five patients. Living donor transplant was performed in six cases. The immunosuppression regimen was identical in all patients and there were nine acute rejection episodes. The most frequent pre -transplant cardiovascular risk factors were dyslipidemia (90.3%), hypertension (70.8%) and anemia (61.9%). After transplant there was a decrease of all cardiovascular risk factors except for overweight/obesity. Although a better control of hypertension was granted, the decrease was not significant. Hypoalbuminemia and dyslipidemia decreased from the 6 -month evaluation on (p<0.001) and left ventricular hypertrophy and anemia from the second year on (p<0.05). Conclusions: We aimed to evaluate the evolution of cardiovascular risk factors in pediatric patients before and after kidney transplant. In our cohort there was a decrease in all studied cardiovascular risk factors after kidney transplant, except for overweight/obesity. This could mean that chronic kidney disease related factors decrease with time, but traditional risk factors may persist or increase, and need active prevention.

Effects of the COVID-19 lockdown on primary health care for persons with type 2 diabetes – Results from the German Disease Analyzer database

ObjectivesTo identify the effects of the first lockdown in Germany (March to May 2020) on glycemic control, BMI, and cardiovascular risk factors in persons with type 2 diabetes. MethodsThe nationwide Disease Analyzer database includes a representative panel of physicianś practices in Germany providing anonymized real-world patient data. For metabolic and renal factors, we estimated absolute changes of means comparing outcomes from June to November 2020 to outcomes in the same persons from June to November 2019, and June to November 2018, respectively. ResultsIn 32,399 patients with type 2 diabetes, HbA1c change between 2019 and 2020 was + 0.04% (95 %CI: 0.03%; 0.05%) compared to −0.02% (95 %CI: −0.03%; −0.01%) between 2018 and 2019. Metabolic risk factors and creatinine changed only little between June to November 2019 and June to November 2020. The proportions of patients with BMI ≥ 30 kg/m2 were 56%, 55%, and 54% in June to November 2018, 2019, and 2020, respectively. The corresponding proportions for HbA1c > 53 mmol/mol Hb (>7.0%) were 39%, 39%, and 40%. ConclusionsThere is little evidence that the first COVID-19 lockdown in Germany had a short-term harmful influence on acute health care outcomes and vascular risk factors in people with type 2 diabetes.

380-P: Endothelial Glycocalyx Dimensions and Cardiovascular Risk Factors in Type 1 Diabetes

Background: The glycocalyx lines the inner surface of the capillary endothelium. Capillaroscopy enables visualization of the sublingual capillaries and measurement of the perfused boundary region (PBR) as an estimate of the glycocalyx. Novel software enables assessment of the PBR estimated at a fixed high flow level (PBR-hf) and the microvascularity by the MicroVascular Health Score (MVHS). Damaged glycocalyx may represent microvascular damage in diabetes and assessment of its dimension might improve early cardiovascular (CV) risk stratification. Aim: To assess the associations between PBR, PBR-hf and MVHS and CV risk factors in persons with type 1 diabetes (T1D); and to compare PBR, PBR-hf and MVHS in persons with T1D and healthy controls. Methods: Cross-sectional study including 161 persons with T1D stratified by stage of diabetic kidney disease according to level of albuminuria and 50 healthy controls without diabetes. The PBR, PBR-hf and MVHS were assessed by the GlucoCheck device (valid measurements were available in 136 (84.5%) with T1D and in all the controls). Higher PBR and PBR-hf indicate smaller glycocalyx width and lower MVHS represents a worse microvascular health. Results: There were no associations between PBR, PBR-hf or MVHS and the CV risk factors in persons with T1D, except for a higher PBR-hf and a lower MVHS in females (p = 0.01 for both). There was no difference in PBR, PBR-hf or MVHS in persons with normo-, micro- or macroalbuminuria (p ≥ 0.34). PBR was higher and MVHS was lower in persons with T1D as compared to the healthy controls (p ≤ 0.02). After adjustment for CV risk factors the difference in PBR remained significant (p = 0.001). Conclusions: The endothelial glycocalyx dimension was impaired in persons with T1D compared to healthy controls. We found no association between the endothelial glycocalyx dimension and the level of albuminuria or CV risk factors among persons with T1D. The use of the GlucoCheck device in T1D may not contribute to CV risk stratification. Disclosure E. Buur stougaard: Employee; Spouse/Partner; Novo Nordisk, Stock/Shareholder; Spouse/Partner; Novo Nordisk. S. Winther: None. H. Amadid: Stock/Shareholder; Self; Novo Nordisk A/S. M. Frimodt-moeller: None. F. Persson: Advisory Panel; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Mundipharma International, Novo Nordisk, Advisory Panel; Spouse/Partner; AstraZeneca, Bristol-Myers Squibb Company, Research Support; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Mundipharma International, Novo Nordisk. T. W. Hansen: Stock/Shareholder; Self; Novo Nordisk A/S. P. Rossing: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Merck KGaA, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Vifor Pharma Management Ltd. Funding Novo Nordisk Foundation (NNF14SA0003)

Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial

IntroductionEvidence on the effects of structured nutrition education is weak in adults with type 1 diabetes mellitus (T1D) with moderately impaired glycemic control. Objective was to compare the effects of...

Abstract WP518: Use of American Heart Association/American Stroke Association Secondary Stroke Prevention Recommendations in Hispanic/Latino Adults With Stroke/TIA: The Hispanic Community Health Study/Study of Latinos

Background: Population studies showed that Hispanic/Latino adults have elevated rates of uncontrolled cardiovascular risk factors (CVRFs) with noticeable sex-specific variations . We investigated prevalence of CVRFs and the use of American Heart Association (AHA) secondary stroke prevention strategies in Hispanics/Latinos in the United States. Methods: Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were used to examine sociodemographic characteristics, use of antithrombotic agents and statins, and treatment of CVRFs in persons with a history of stroke or transient ischemic attack (TIA). CVRFs were categorized as “controlled” if the CVRF met the goals defined by the AHA irrespective of whether the subject was on treatment for it or not; and “unaware” if the participant denied having a CVRF but met the diagnostic criteria for it. Differences between men and women were tested using ANOVA test and Pearson’s χ 2 . Factors associated with adherence to AHA recommendations were investigated using logistic regression. Results: These analyses included 404 individuals with history of stroke/TIA (men=159; women=245). Women were slightly older than men (55.1±1.5 vs. 54.1±1.6 years; p<0.0001). The prevalence of hypertension (HTN), hypercholesterolemia (HC), and diabetes (DM) were 59%, 65% and 39%. The rates of awareness/controlled CVRFs were 90%/49%, 75%/32%, and 83%/54% for HTN, HC, and DM, respectively. Approximately 49% of the individuals were on antithrombotic agents, 39% on statins, and 26% on dual treatment with antithrombotics and statins. Rates were comparable between men and women except for HC control which was lower in women (41±6% vs. 23±5%; p=0.02). In logistic regression analysis, older age was associated with poorer adherence to AHA recommendations. Female sex and residence >10 years in the US were associated with uncontrolled HC and DM, respectively. Conclusion: Hispanics/Latinos with stroke have elevated rates of awareness but suboptimal use of AHA secondary stroke prevention strategies. Older persons and women are vulnerable groups that may benefit from targeted interventions.

Assessment of cardiovascular risk factors in persons with impaired glucose tolerance

Introduction/Objective. The aim of the study was to determine the profile of cardiovascular risk factors in patients with impaired glucose tolerance (IGT) in comparison to patients with impaired fasting glucose (IFG). Methods. The study consisted of 222 adult participants with established fasting blood glucose values within the 5.6?6.9 mmol/L range. IGT was defined as blood glucose of 7.8?11.1 mmol/L in the second hour after the administration of 75 g during oral glucose tolerance test. IFG is the metabolic state between normal and impaired glucose tolerance, where fasting glucose levels are 5.6?6.9 mmol/L, and normal oral glucose tolerance test values. IGT was confirmed in 142 of these individuals (107 females and 35 males; aged 54 ? 13 years). The remaining 80 participants (56 females and 24 males, p = 0.329; aged 53 ? 13 years, p = 0.76) were considered the IFG group. The following parameters were analyzed in both groups: body mass index, waist circumference, blood pressure, fasting glucose, fasting insulin levels, HOMA-IR (homeostasis model assessment ? insulin resistance), C-reactive protein, fibrinogen concentrations and lipid profile. Results. Participants in the IGT group were more obese than those in the IFG group (body mass index 30.8 ? 5.5 kg/m2 vs. 26.7 ? 3.8 kg/m2, p < 0.001), and with greater waist circumference (111 ? 12 cm vs. 101 ? 6 cm; p < 0.001). Glucose levels (6.02 ? 0.75 mmol/L vs. 5.80 ? 0.62 mmol/L; p < 0.001), and blood insulin levels (21.61 ? 3.46 vs. 6.00 ? 2.8 mIU/L; p < 0.001), as well as HOMA-IR (5.78 ? 2.68 mIU/L vs. 1.54 ? 1.46 mIU/L; p < 0.001) were also higher in the IGT group. Median levels of HbA1c in IGT subjects were higher compared with those in the IFG group, but the difference was not statistically significant (6.21 ? 0.75% vs. 5.92 ? 0.43%; p = 0.105). Median hs-CRP levels in the IGT subjects (6.7 ? 4.88 mg/L) were higher than in the IFG subjects (5.83 ? 6.47 mg/L), but without statistical significance (p = 0.76). Conclusion. Our study indicates the presence of a large number of cardiovascular risk factors in both groups. Still, obesity, hyperinsulinemia, hypercholesterolemia, hypertriglyceridemia, higher diastolic blood pressure, as well as sedentary lifestyle, were statistically significantly more prevalent in patients with IGT.

Potential Cardioprotective Effects of Sumac Capsule in Patients With Hyperlipidemia: A Triple-Blind Randomized, Placebo-Controlled Crossover Trial

ABSTRACTObjective: Alternative medicine and herbal drugs have been taken into account for managing cardiovascular risk factors. Sumac (Rhus coriaria L.) is rich in biologically active ingredients known to improve cardiovascular health. We investigated the effect of sumac on systolic (SBP) and diastolic (DBP) blood pressure, flow-mediated dilation (FMD), body mass index (BMI), and serum concentrations of lipids and fasting blood sugar (FBS) in participants with hyperlipidemia in a triple-blind randomized placebo- controlled crossover trial.Methods: Thirty adults with dyslipidemia (mild to moderate elevation of plasma total cholesterol and/or triglycerides [TG; total cholesterol ≥ 6.0 mmol/L or TG ≥ 1.7 mmol/L and TG ≤ 5.0 mmol/L]) were assigned randomly to a sumac or a placebo group. Participants in the sumac group received sumac capsules (500 mg/twice daily) for the first 4 weeks, followed by 2 weeks’ washout period; the patients were then switched to a 4-week interval and received placebo for 4 weeks in the second period. The placebo group received these treatments in reverse order. FMD, BMI, SBP, DBP, lipids, and FBS were measured at baseline and after each period. Results: Differences between placebo group and sumac group (placebo-sumac) were significantly decreased for BMI (0.21 ± 0.075 kg/m2), SBP (1.87 ± 0.83 mm Hg), DBP (1.32 ± 0.46 mm Hg), and total cholesterol (14.42 ± 4.95 mmol/L) and significantly increased for FMD (−0.23% ± 0.065%). Plasma level of TG did not change significantly across the treatment. Conclusion: Sumac consumption may decrease cardiovascular risk factors in persons with mild to moderate hyperlipidemia.

Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors.

Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk. A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors. Separately, the personalization of coronary risk factors was determined by having patients list their individual risk factors for having a heart attack. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient's misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity. Between October 2006 and April 2008, 1584 consecutive patients were screened, and 1051 patients were enrolled. Participants were 57.5% female and 62.8% self-identified White, 22.5% Black, and 11.5% Hispanic. Misperception about personal risk was significantly higher in non-White compared with the White participants for diabetes (in Blacks [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.08-5.57] and Hispanics [OR, 3.50; 95% CI, 1.49-8.20]) and for hyperlipidemia (in Hispanics [OR, 2.21; 95% CI, 1.19-4.10]). Although the majority (85%) had a primary care physician, Blacks and Hispanics were less likely to have access to information (OR, 0.25; 95% CI, 0.10-0.49; and OR, 0.71; 95% CI, 0.37-1.04, respectively). There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups.

Impact of high-intensity concurrent training on cardiovascular risk factors in persons with multiple sclerosis – pilot study

Purpose: High-intensity concurrent training positively affects cardiovascular risk factors. Because this was never investigated in multiple sclerosis, the present pilot study explored the impact of this training on cardiovascular risk factors in this population.Methods: Before and after 12 weeks of high-intense concurrent training (interval and strength training, 5 sessions per 2 weeks, n = 16) body composition, resting blood pressure and heart rate, 2-h oral glucose tolerance (insulin sensitivity, glycosylated hemoglobin, blood glucose and insulin concentrations), blood lipids (high- and low-density lipoprotein, total cholesterol, triglyceride levels) and C-reactive protein were analyzed.Results: Twelve weeks of high-intense concurrent training significantly improved resting heart rate (−6%), 2-h blood glucose concentrations (−13%) and insulin sensitivity (−24%). Blood pressure, body composition, blood lipids and C-reactive protein did not seem to be affected.Conclusions: Under the conditions of this pilot study, 12 weeks of concurrent high-intense interval and strength training improved resting heart rate, 2-h glucose and insulin sensitivity in multiple sclerosis but did not affect blood C-reactive protein levels, blood pressure, body composition and blood lipid profiles. Further, larger and controlled research investigating the effects of high-intense concurrent training on cardiovascular risk factors in multiple sclerosis is warranted.Implications for rehabilitationHigh-intensity concurrent training improves cardiovascular fitness.This pilot study explores the impact of this training on cardiovascular risk factors in multiple sclerosis.Despite the lack of a control group, high-intense concurrent training does not seem to improve cardiovascular risk factors in multiple sclerosis.

The Effects of Chronic Aerobic Exercise on Cardiovascular Risk Factors in Persons with Diabetes Mellitus.

Aerobic exercise training is a component of diabetes mellitus (DM) care guidelines due to its favorable effects on glycemic control and cardiovascular disease (CVD) risk factors. The purpose of this review is to outline the recent evidence regarding the clinical effects of chronic aerobic exercise on CVD risk factors in persons with DM and to compare the effects of varying intensities and types of exercise. Among individuals with DM, all types of aerobic exercise training can impact positively on some traditional and non-traditional risk factors for CVD. Training programs with a higher volume or intensity induce greater improvements in vascular function, cardiorespiratory fitness (CRF), and lipid profiles. The beneficial outcomes of aerobic training include improvements in glycemic control, endothelial function, oxidative stress, dyslipidemia, myocardial function, adiposity, and CRF. Findings regarding markers of inflammation are discrepant and further research should focus on the role of exercise to impact upon the chronic inflammation associated with DM.

Abstract P213: Industry and Non-Profit Partnerships as an Effective Model for Implementation of Community-Based Nutrition Interventions

Introduction: Consuming fruits, vegetables and whole grains is associated with lower risk of cardiovascular disease. Community-based nutrition programs are an effective approach to changing attitudes and behaviors around food and health in underserved populations. The American Heart Association and Aramark launched Healthy for Life 20 by 20, a five-year initiative to increase fruits, vegetables and whole grains by 20 percent. A major focus of their collaboration was the development and implementation of a 12-week community-delivered nutrition engagement pilot. The purpose of this pilot was to evaluate the effectiveness of this health program in improving healthy food purchasing behaviors, nutrition and lifestyle choices. Methods: A 12-week pilot intervention was designed and implemented in three cities at five community centers March-June 2016. Weekly sessions were focused on enhancement of healthy cooking and shopping skills, nutrition education, and assessment of personal cardiovascular risk factors. Participating centers had the option to choose from two delivery methods: optimal and flexible. Participant fruit and vegetable intake, whole grain intake, and number of meals prepared at home were assessed before and after completion of the intervention. Results: Study participants (n=119) were predominately female (79%), Hispanic (60%) and African-American (27%), had high school or lower educational attainment (67%), lower income (39% < $20K, 40% $20K-$39.9K), young and middle ages (45% <34 years old, 27% 35-44), and 52% had ≥ 2 children living in their household. Three-quarters of participants (76%) had no previous experience participating in health and wellness programs. The median consumption of fruits/vegetables among participants increased by 2 servings/day (3.0 to 5.0) and over two-thirds of participants (69%) increased their fruit/vegetable consumption by at least 1/2 a serving. The median consumption of whole grains increased by 1 serving/day (1.0 to 2.0) and half (48%) of participants increased their whole grain consumption by at least 1 serving. Forty-five percent of participants (n=87) increased their percentage of eaten meals prepared at home each week. Conclusions: The use of industry and non-profit partnerships in a community engagement format can be an effective way to facilitate programs focused on increasing consumer trust for shopping and cooking, to build confidence of new skills, and to empower individuals to improve their health and potentially the health of their family. These results suggest that this community engagement partnership approach can positively transform health in communities and drive the American Heart Association’s goal of improving Americans’ health by 20% by 2020.

Abstract P092: Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors

Background: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of cardiovascular risk factors accurately reflects personalization of one’s own cardiovascular risk especially in different ethnic groups. Methods: A cross-sectional survey was performed in consecutive patients presenting with chest pain and admitted to a large, urban Chest Pain Center at Yale-New Haven Hospital. A 32-item multiple item questionnaire was administered in English or Spanish to examine knowledge of CHD risk factors. Separately, the personalization of coronary risk factors was determined by having patients list [write in] their individual risk factors for having a heart attack. Multivariate logistic regression model and odds ratios were used to evaluate predictors of misperception, defined as gap between knowledge and personalization of risk. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient’s misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity. Results: Between Oct 2006-April 2008, 1584 consecutive patients admitted to the Chest Pain Center were screened for eligibility, and 1051 patients were enrolled. Between Hispanic, White, and African American patients, Hispanic patients were least aware of major CHD risk factors. In addition, misperception about personal risk was significantly higher in nonwhite compared to the white participants. This disparity persisted for the major modifiable coronary risk factors including hyperlipidemia and diabetes even when controlled for age, gender, employment, marital status, prior history of CAD and sources of health information. Conclusion: Knowledge of CHD risk factors vary by ethnicity. In addition, there are major gaps between awareness and personalization of risk in major modifiable CHD risk factors in different ethnic groups.

Abstract 158: Central arterial elasticity in patients post Kawasaki Disease - a Cardiac Magnetic Resonance Imaging (CMR) study

Background: Measures of central arterial elasticity such as aortic pulse wave velocity (APWV) have been shown to correlate with development of atherosclerosis. Endothelial dysfunction after Kawasaki disease has been shown to persist despite resolution of anatomically demonstrable coronary anomalies and this may be reflected in abnormal central arterial elasticity. Measurement of APWV by CMR is most robust but has seldom been reported in KD patients. Aim: In a novel pilot study, we measured the APWV using CMR in patients with no coronary complications post KD. We compared this to age and gender matched published controls and APWV values measured on ultrasound. Methods: 10 KD patients (with no coronary involvement) in our hospital database, at least 12 years post KD diagnosis, with no known personal cardiovascular risk factors or family history of premature cardiovascular disease, were recruited. Each subject underwent both MRI and ultrasound investigations to determine the APWV. The results were compared using standard (z) scores calculated from published norms. Results: 3 of the 10 KD subjects had significant z scores using CMR measurements of APWV ranging from +2.07 to +3.35. However, no significant difference was found on overall non parametric comparisons of measurements. The US measurements of APWV all did not yield significant z scores. Z scores obtained from US and CMR measurements for the same subject showed no concordance. Conclusion: Central arterial stiffness tends to be higher in KD patients many years following the acute illness when assessed by CMR methods. CMR may be a more sensitive method than ultrasound for assessing central arterial stiffness post KD. The clinical implication of these findings require longitudinal follow up.

P019: Prevalence of cardiovascular risk factors in persons living with HIV at high activity antiretroviral therapy in Mexico City

P019: Prevalence of cardiovascular risk factors in persons living with HIV at high activity antiretroviral therapy in Mexico City

A randomised trial of salsalate for insulin resistance and cardiovascular risk factors in persons with abnormal glucose tolerance

Chronic sub-acute inflammation contributes to the pathogenesis of type 2 diabetes mellitus and cardiovascular disease. High doses of salicylate reduce inflammation, glucose and triacylglycerols, and may improve insulin sensitivity, suggesting therapeutic potential in impaired fasting glucose and/or impaired glucose tolerance. This trial aimed to evaluate the effect of salsalate vs placebo on insulin resistance and glycaemia in impaired fasting glucose and/or impaired glucose tolerance. We conducted a 12 week, two-centre, randomised, placebo-controlled study to evaluate the effect of salsalate (up to 4 g/day) vs placebo on systemic glucose disposal. Secondary objectives included treatment effects on glycaemia, inflammation and cardiovascular risk factors. Seventy-eight participants with impaired fasting glucose and/or impaired glucose tolerance from two VA healthcare systems were enrolled. Randomisation assignment was provided by the coordinating center directly to site pharmacists, and participants and research staff were blinded to treatment assignment. Seventy-one individuals were randomised to placebo (n = 36) or salsalate (n = 35). Glucose disposal did not change in either group (salsalate 1% [95% CI -39%, 56%]; placebo 6% [95% CI -20%, 61%], p = 0.3 for placebo vs salsalate). Fasting glucose was reduced by 6% during the study by salsalate (p = 0.006) but did not change with placebo. Declines in glucose were accompanied by declines in fasting C-peptide with salsalate. Insulin clearance was reduced with salsalate. In the salsalate group, triacylglycerol levels were lower by 25% (p = 0.01) and adiponectin increased by 53% (p = 0.02) at the end of the study. Blood pressure, endothelial function and other inflammation markers did not differ between groups. Adipose tissue nuclear factor κB (NF-κB) activity declined in the salsalate group compared with placebo (-16% vs 42%, p = 0.005), but was not correlated with metabolic improvements. The frequency of tinnitus was low but tended to be higher with salsalate therapy (n = 4 vs n = 2). In summary, salsalate therapy was well tolerated, lowered fasting glucose, increased adiponectin and reduced adipose tissue NF-κB activity. These changes were not related to changes in peripheral insulin sensitivity, suggesting additional mechanisms for metabolic improvement. ClinicalTrials.gov NCT00330733. Office of Research and Development, Medical Research Service, Department of Veterans Affairs and NIH K24 DK63214.

Adiponectin and arterial stiffness in youth with type 1 diabetes: the SEARCH for diabetes in youth study.

Persons with type 1 diabetes are at increased risk of developing vascular disease. Adiponectin concentrations may play an intermediate role in this process. We sought to determine whether adiponectin is correlated with vascular stiffness in adolescents with type 1 diabetes. Plasma adiponectin, pulse wave velocity (PWV), augmentation index (AIx-75), and brachial distensibility (BrachD) were collected in 225 adolescents. Outcomes were evaluated by sex, and regression models were used to determine whether adiponectin was an independent determinant of arterial stiffness. Males had lower adiponectin levels and stiffer vessels (lower BrachD, p < 0.01) than females. Unadjusted correlations revealed that adiponectin was correlated with BrachD (p < 0.01) but not PWV and AIx-75. After adjustment, adiponectin was not a significant predictor of BrachD. The most consistent predictors of increased stiffness were age, male sex, blood pressure, obesity, and total cholesterol (p < 0.05). Adiponectin's contributions to arterial stiffness appear to be masked by other cardiovascular risk factors in persons with type 1 diabetes.

Retinopathy Signs in People without Diabetes: The Multi-Ethnic Study of Atherosclerosis

To describe the prevalence of retinopathy and associations with cardiovascular risk factors in persons without diabetes in 4 racial/ethnic groups (white, black, Hispanic, and Chinese). Population-based, cross-sectional study. We included 6176 subjects aged 45-84 years without diabetes, selected from 6 United States communities. Fundus images were taken using 45° digital camera through dark-adapted pupils and were graded for retinopathy as defined by the Early Treatment Diabetic Retinopathy Study severity scale: microaneurysms, hemorrhages, cotton wool spots, intraretinal microvascular abnormalities, hard exudates, venous beading, and new vessels. Retinopathy and the association with cardiovascular risk factors. Prevalence rates of retinopathy in persons without diabetes were 12.5% overall, varying from 11.9% (white), 13.9% (black), 12.6% (Hispanic), to 17.2% (Chinese). Hypertension was strongly associated with retinopathy (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.23-1.75). After adjusting for age, gender, race, and other parameters, smoking (OR, 1.50; 95% CI, 1.09-2.06) and increased internal carotid intima media thickness (OR, 1.22; 95% CI, 1.05-1.41) were associated with retinopathy. A range of serum inflammatory factors were examined, but none were found to be significant. Retinopathy in persons without diabetes is common, varies with race/ethnicity, and associated with cardiovascular risk factors, including hypertension, smoking, and carotid artery intima media thickness.

Cardiovascular Risk Factors and Cognition in the Oldest Old: What Doesn't Kill You Makes You (Cognitively) Stronger?

Evidence implicating cardiovascular risk factors (CVRFs) in cognitive compromise comes primarily from studies of elderly who are in their 70s. CVRFs in the cognitively healthy oldest-old (85+) have rarely been studied. We present results from several clinical and neuropathological studies suggesting that some relationships consistently observed in the young-old are weakened or even reversed with increasing age. The clinical studies assessed cognitive function and CVRFs (lipid panel, C-reactive protein, plasma homocysteine, and ejection fraction and left atrial diameter from echocardiogram) in 150+ (numbers vary slightly depending on the CVRF) very old cognitively healthy participants. Partial correlations controlling for age, sex, and education were used to examine the relationship between four cognitive domains (memory, executive functions, attention, and language) and individual CVRFs. The neuropathological studies assessed the relationships between diabetes and hypertension medication use with the hallmark lesions of Alzheimer's disease, neuritic plaques and neurofibrillary tangles. ANCOVA controlling for age at death, dementia severity, and sex compared extent of NPs and NFTs in several brain regions, in groups with and without medications, separately for oldest-old and young-old. Contrary to the expected in young elderly, all CVRFs assessed were associated with better cognitive performance, particularly with executive functions. Diabetes medications (concomitant insulin with hypoglycemic medications) and hypertension medications (of any kind) were associated with less AD neuropathology, but these associations were consistently weaker in the oldest-old. The consistent pattern for elevated systemic CVRFs with better cognitive function and the weaker relationships of CVRF medication use with AD neuropathology in the oldest-old is striking and consistent with recent reports from other groups. While limited by the cross-sectional nature of the analyses, one potential explanation for these findings is that cognitive functions are less vulnerable to the neurobiological effects of CVRFs in persons who for genetic/epigenetic/environmental reasons survive to extreme old age. An alternative explanation is antagonistic pleiotropy, i.e. those who survive to extreme age undergo continuous and complex physiological adaptations that contribute to longevity and healthy cognition. In either case, clinical or mechanistic extrapolation of relationships of CVRFs with cognitive compromise in young-old to the oldest-old might be erroneous.