Cardiovascular Risk In General Population Research Articles

Marital status and long-term cardiovascular risk in general population (Gubbio, Italy)

To investigate whether marital status is associated to long-term major fatal and non-fatal cardiovascular events in men and women from the Gubbio Population Study. The incidence of cardiovascular disease (CVD), including stroke and coronary heart disease (CHD) and CVD death together with all-cause mortality were analyzed. The analysis included 2832 persons (44% men, 54 ± 11 years old). Marital status was defined at entry as married (married or living conjugally) versus unmarried subjects (widowed, separated, divorced or single). Married and unmarried subjects did not differ concerning socio-demographic, anthropometric and biological variables at baseline. Over 191 months median follow-up, the incidence of CHD was lower among married versus unmarried women [HR: 0.63 (95% CI 0.41–0.96)] only; the same was true for CHD mortality [HR: 0.43 (95% CI 0.22–0.84)] and all-cause mortality [HR: 0.75 (95% CI 0.59–0.96)] independently of traditional risk factors (age, SBP, total and HDL cholesterol, cigarette smoke and BMI). In men, marital status was not associated to any of the investigated outcomes. In primary care, marital status should be investigated as it can be associated with long-term CHD and all-cause incidence and mortality risks among women.

Профіль чинників ризику серцево-судинних захворювань при ішемічній хворобі серця в осіб із нормальним і порушеним вуглеводним обміном

Мета дослідження: провести порівняльний аналіз профілю чинників ризику розвитку серцево-судинних захворювань у хворих на ішемічну хворобу серця (ІХС) з нормальним і порушеним вуглеводним обміном. Матеріали і методи. Під спостереженням перебували 142 пацієнти. З метою оцінки частоти різних форм ІХС залежно від стану вуглеводного обміну були сформовані такі групи: перша група — 83 хворі на цукровий діабет (ЦД) 2-го типу, друга група — 34 хворі з порушенням толерантності до глюкози (ПТГ), третя група — 25 пацієнтів із нормальним вуглеводним обміном. Для виявлення ішемічних змін міокарда проводили амбулаторний добовий моніторинг електрокардіограми з обов’язковим досягненням субмаксимальної частоти серцевих скорочень у процесі дослідження. Результати. Безбольова ішемія міокарда була виявлена у 19 (22,9 %) хворих на ЦД 2-го типу, у 3 (8,8 %) осіб із ПТГ і у 2 (8,0 %) пацієнтів із нормальним вуглеводним обміном. Паління, обтяжена спадковість, порушення в системі гемостазу вірогідно частіше траплялися в групі хворих на ЦД 2-го типу з безбольовою ішемією міокарда порівняно з хворими на ЦД 2-го типу без ІХС. Профіль загальнопопуляційних чинників ризику розвитку серцево-судинних захворювань у хворих на ІХС і цукровий діабет 2-го типу належить до найбільш несприятливих. У той же час у пацієнтів із ранніми порушеннями вуглеводного обміну і нормальним вуглеводним обміном він статистично значимо не розрізняється. Висновки. Хворі на ЦД 2-го типу з безбольовою ішемією міокарда порівняно з хворими на ЦД 2-го типу без ІХС мають вірогідно більш виражені порушення показників загальнопопуляційних чинників ризику розвитку серцево-судинних захворювань.

Lipoprotein (a) and cardiovascular risk in familial combined hyperlipidaemia: does it exist?

Abstract Background Previous studies suggest there is an association between levels of lipoprotein a [Lp (a)] and increased cardiovascular risk in general population and familial hypercholesterolaemia patients. The purpose of this study was to define the exact relationship between the levels of Lp (a) and cardiovascular risk in a Familial Combined Hyperlipidaemia (FCH) population. Methods We enrolled 1094 (615 males, mean age 49 years old) patients who fulfilled the FCH criteria, from the outpatient lipid clinic of our hospital. Lp (a) levels were measured and information were obtained regarding demographic characteristics, the presence of coronary artery disease (CAD) and CAD risk factors. Patients were categorized initially according to baseline Lp (a) levels to quintile 1 (≤30mg/dl) (N=769), quintile 2 (>30 mg/dl, ≤50mg/dl) (N=149), quintile 3 (>50mg/dl, ≤100mg/dl) (N=124), quintile 4 (>100mg/dl, ≤150mg/dl) (N=31), and quintile 5 (>150mg/dl) (N=21). We calculated the percentage of patients with CAD in each quintile. Additionally, we performed logistic regression analysis to predict the presence of CAD based on the levels of Lp (a) and other CAD risk factors, age, sex, the presence of diabetes mellitus, hypertension and smoking. Results Mean value for Lp (a) in the whole population was 29.67mg/dl. The percentages of CAD were 13.1%, 16.8%, 15.3%, 22.6%, and 23.8% respectively for quintiles 1–5 (Figure 1). The number of CAD patients increases as baseline Lp (a) levels increase. To further support the finding, regression analysis revealed that age, gender and Lp (a) added significantly to the model. Lp (a) could predict CAD, independently of other factors. Conclusions The correlation between Lp (a) and Familial Combined Hyperlipidaemia is unclear. There is an increasing trend for the presence of CAD in higher Lp (a) levels and a positive relationship, indicating a straightforward correlation between these two parameters. Funding Acknowledgement Type of funding sources: None.

POS0728 QRISK3 RELATION TO CAROTID PLAQUE IS HIGHER THAN THAT OF SCORE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:Systemic lupus erythematosus (SLE) has been described as an independent risk factor for the development of cardiovascular (CV) disease. Recently, QRESEARCH risk estimator version 3 (QRISK3) calculator has been released for the assessment of CV risk in general population. QRISK3 now includes the presence of SLE as one of its variables for the calculation of CV risk.Objectives:We aim to compare, in patients with SLE, the predictive capacity between QRISK3 and Systematic COronary Risk Evaluation (SCORE) for the presence of carotid subclinical atherosclerosis.Methods:296 patients with SLE were recruited. The presence of carotid plaque and carotid intima media thickness (cIMT) were assessed through ultrasound. QRISK3 and SCORE were calculated. The relation of QRISK3 and SCORE between themselves and to the presence of carotid subclinical atherosclerosis (both carotid plaque and cIMT) was studied.Results:Most of the patients were female (95%) and average age was 51 ± 12 years. Traditional cardiovascular risk factors were prevalent, as shown in table 1. Most SLE patients were in the no activity (41%) or mild activity (29%) categories as shown by the SLEDAI scores. SLICC and Katz indexes were, respectively, 1 (IQR 0-2) and 2 (IQR 1-4). Seventy-one percent of the patients had a SLICC/ACR DI score equal to or higher than 1, and 39% had a Katz index equal to or higher than 3. Almost half of the patients (47%) were taking prednisone (the median dose of those 139 patients on prednisone was 5 [IQR 2.5-5] mg/day at the time of the study). DMARDs use was reported in 77% of the patients and 69% were taking hydroxychloroquine at the time the study was performed. SCORE and QRISK3 did not correlate between them in patients with SLE. In this sense, QRISK3, both calculated including the SLE item (Rho Spearman r=-0.008, p=0.90) or not (Rho Spearman r=-0.009, p=0.96), did not correlate with SCORE. This lack of correlation was also found when the corresponding categorizations of both scores were used. For example, patients with a QRISK> = 10 did not show a higher SCORE when compared to patients with a QRISK3 <10 (1.26 vs. 1.30, p=0.90). Similarly, QRISK3 was not different between the low, moderate, high and very-high SCORE CV risk categories.Relation of QRISK3 and SCORE to cIMT and to the presence of carotid plaque is shown in Figure 1. QRISK3 was statistically significantly correlated with cIMT (Rho Spearman r=-0.420, p=0.000). However, this relation was not found between SCORE and cIMT (Rho Spearman r=-0.005, p=0.93). Moreover, QRISK3 showed a statistically significant discrimination for the presence of carotid plaque (AUC 0.765 (95%CI 0.711-0.820). This relation was found to be significant both when QRISK3 was calculated with the SLE variable item or not. However, in patients with SLE, SCORE did not show a significant discrimination for the presence of carotid plaque (0.561 (95%CI 0.494-0.629). Additionally, a statistical significant difference was observed between the AUC of QRISK3 and SCORE (p=0.000).Table 1.Characteristics of SLE patientsSLE patients(n=296) Age, years51 ± 12 Female, n (%)280 (95) Body mass index, kg/m227 ± 6 Systolic blood pressure, mmHg127 ± 19Cardiovascular co-morbidity Smoking, n (%)74 (25) Diabetes, n (%)14 (5) Hypertension, n (%)119 (40) Dyslipidemia, n (%)115 (39)Analytical and lipid profile CRP, mg/dl1.9 (0.9-4.9) Cholesterol, mg/dl198 ± 38 LDL cholesterol, mg/dl110 ± 29SLE related dataDisease duration, years17 (10-25)SLICC1 (0-2)SLEDAI2 (0-4)Current prednisone, n (%)139 (47)Hydroxychloroquine, n (%)205 (69)Subclinical atherosclerosisCarotid IMT, microns630 ± 122Carotid plaques, n (%)108 (36)Figure 1.Relation of QRISK3 and SCORE to cIMT and carotid plaque.Conclusion:QRISK3 discrimination for carotid plaque is higher than that of the SCORE. QRISK3, and not SCORE, should be use for the calculation of CV risk in patients with SLE.Disclosure of Interests:None declared

Carotid plaques in adult rheumatoid arthritis patients; association with paroxonase 1 enzymatic activity and Q192R paroxonase 1 gene polymorphism.

Paroxonase 1 (PON 1) enzymatic activity and Q192R PON polymorphism has been implicated with greater cardiovascular risk in general population. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized with increased inflammatory markers leading to increased cardiovascular morbidity. The aim of the work was to study association between PON1 enzymatic activity & gene polymorphism with carotid plaques in RA patients. This case-control study was carried out at Zagazig University Hospitals on 99 subjects divided randomly into two groups; 48 RA patients and 51 controls. RA patients fulfilled the revised 2010 EULAR/ACR classification criteria of RA. All patients were subjected to history taking, clinical evaluation, laboratory investigations & plain X-rays. Carotid intima-media thickness (CIMT) and PON1 enzyme assay & genotyping were done for both groups. PON1 enzyme levels were significantly higher in patients than controls. Also, there was a significant negative correlation of PON1 enzyme activity with increased CIMT & plaques. The cut-off value of PON1 enzyme level that had the highest CVD prediction was 4.2 U/ml. Although PON1 genotyping was insignificantly different between patients and controls, patients with QQ genotype had the lowest PON1 activity then patients with QR genotype then RR genotype. In RA patients, decreased serum PON1 enzymatic activity and QQ genotyping of Q192R PON polymorphism was associated with increased CIMT & plaques. Serum PON1 could be a good marker for atherosclerosis prediction in RA patients at cutoff 4.2 U/ml.

Gender difference in the association between brachial-ankle pulse wave velocity and cardiovascular risk scores.

Background/AimsAlthough brachial-ankle pulse wave velocity (baPWV) has been validated as a novel method to predict the cardiovascular risk in general population, the relevance of baPWV to the traditional risk scores has not been clearly revealed. This study investigated the relationship between baPWV and four different cardiovascular risk-predicting scores in men and women.MethodsA total of 539 subjects (58.1 ± 12.2 years, 50.1% men) without cardiovascular disease (CVD) who underwent health examinations including baPWV measurement were retrospectively analyzed. Four cardiovascular risk scores (Framingham risk score [FRS; 1998], Adult Treatment Panel [ATP] III revised FRS [2002], generalized FRS [2008], and American College of Cardiology/American Heart Association [ACC/AHA] CVD risk [2013]) were calculated in each subject.ResultsIn a total population, baPWV was moderately correlated with four cardiovascular risk scores (r = 0.577 for FRS; r = 0.594 for ATP III revised FRS; r = 0.589 for generalized FRS; r = 0.571 for ACC/AHA CVD risk; p < 0.001 for each). These correlations were stronger in women than in men (r = 0.649 vs. 0.451 for FRS; r = 0.719 vs. 0.411 for ATP III revised FRS; r = 0.735 vs. 0.540 for generalized FRS; r = 0.699 vs. 0.552 for ACC/AHA CVD risk; p for gender difference ≤ 0.005 for each).ConclusionsIn middle-aged and elderly Koreans without CVD, baPWV was identified as having a moderately positive correlation with four different risk scores. The correlation was stronger in women than in men, implying the better performance of baPWV in women for predicting cardiovascular risk of healthy population.

75 Central blood pressure and arterial stiffness in various forms of hypertension in pregnancy

Introduction Arterial stiffness and central pressure measurements should be considered as recommended tests for the evaluation of cardiovascular risk in general population, whereas in pregnancy, their meaningfulness is not established. The estimation of these parameters for early detection of preeclampsia may be helpful. Objectives To evaluate the central (aortic) blood pressure (BP) and arterial stiffness in women with various forms of hypertension and their prognostic role in development of preeclampsia (PE). Methods In a prospective cohort study there were included 300 pregnant women: 106 – with chronic hypertension (CH) – group 1; 63 – with gestational hypertension (GH) – group 2; 10 – with PE – group 3; 21 – with preeclampsia superimposed on chronic hypertension (CH+PE) – group 4 and 100 – without hypertension (comparison group) – group 5. Ambulatory BP monitoring oscillometric measurement method with the definition of the central (aortic) BP and arterial stiffness parameters (augmentation index, reflected wave transit time, arterial stiffness index) in 16–22 weeks of pregnancy was performed in all patients using a 24–h BP monitoring system, ie, BPLab® and Vasotens® technology (Petr Telegin, Nizhny Novgorod, Russian Federation). Statistical analysis was performed using the statistical software package MedCalc®, version 11.5.0 (Mann–Whitney test, Kruskal–Wallis test, Pearson’s chi-squared test, logistic regression analysis, ROC-analysis). Statistical significance was considered to be a p Results The average peripheral (brachial) systolic blood pressure (SBP) 24 h was higher in all pregnant women with hypertension: with CH (130 ± 8.8 mmHg), with GAG (136 ± 6.9 mm Hg), with PE (136 ± 6.9 mmHg), with PE superimposed on CH (138 ± 7.9 mmHg) vs comparison group (118 ± 5.1 mmHg p1,2,3,4-5 Conclusions 24-h blood pressure monitoring in pregnant women with hypertension in 16–22 weeks of gestation may be useful to obtain additional information about central SBP and arterial stiffness as a prognostic parameters for prediction of preeclampsia.

Implementation of cardiovascular disease prevention guidelines into clinical practice: an unmet challenge?

Prevention through evaluation and treatment of cardiovascular risk factors is an efficient approach to reduce the risk of cardiovascular events, however, the problem remains that the available treatment options are underused. Implementation of cardiovascular disease prevention guidelines into clinical practice is therefore important for decreasing the burden of cardiovascular disease in general population. However, there are many barriers to this process, including questionable relevance of scientific results for clinical practice, personal preferences and expertise of the doctors, patient attitudes, lack of time, and economical factors. All these factors need to be taken into account for any change in the clinical practice to be successful. With respect to cardiovascular disease prevention, insufficient screening for risk factors, inappropriate risk estimation and hesitation to keep to the guidelines-based treatment targets contribute most to inadequate control of risk factors, and this has been repeatedly demonstrated to be difficult to improve. In this context, our studies demonstrate that the emphasis on systematic application of principles of cardiovascular prevention results in improved control of cardiovascular risk factors. Adequate support for transforming guidelines-based knowledge into practicable habit appears therefore important for successful prevention of cardiovascular disease in clinical practice and may translate into substantial reduction of cardiovascular risk in general population.

THU0250 Cardiovascular risk assessment in systemic sclerosis using the score chart and reclassification by presence of plaques on ultrasonography

BackgroundIncreased cardiovascular (CV) risk and atherosclerosis have been described in patients with rheumatic diseases including systemic sclerosis (SSc). Besides traditional CV risk factors, endothelial dysfunction, and disease-specific factors, such as...

Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

❙ABSTRACT❙ Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction, ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p 80/min, and ejection fraction 80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF. (J Korean Soc Hypertens 2012;18(1):38-45)

Cystatin C and cardiovascular risk in HIV infected patients

Background HIV infection, combined antiretroviral therapy (cART) and metabolic syndrome are associated to an increased cardiovascular risk (CVR). Cystatin C, a low molecular weight cysteine protease inhibitor involved in vascular extracellular matrix remodelling, is considered a novel marker of kidney function and CVR in general population. To value the role of cystatin C in HIV infected patients without chronic kidney disease treated with cART subdivided for CVR.

Utility of Highly Sensitive Cardiac Troponin T Assay for Evaluation of Cardiovascular Risk in General Population

We investigated the utility of a new highly sensitive troponin T (hsTnT) assay (lower detection limit of 0.002ng/mL) for evaluating cardiovascular risk in 206 health checkup examinees without chronic kidney disease. Results: 1) Troponin T was detectable in 91% with a new hsTnT assay compared with 0% with a traditional assay (lower detection limit of 0.01ng/mL). 2) History of cardiovascular disease and/or abnormal electrocardiographic findings (possible cardiovascular disease) was present in 48 patients.