Cardiovascular Risk In Men Research Articles

Sex Differences in Protein Biomarkers and Measures of Fat Distribution.

Sex differences in obesity and fat distribution may in part explain differences in cardiovascular risk in men versus women. We sought to examine sex differences in the associations of obesity and adiposity measures with cardiovascular disease-related protein biomarkers. In a cross-sectional observational cohort study, we examined whether the association of obesity (body mass index [BMI] and waist circumference) and adiposity measures (visceral adipose tissue) with biomarkers demonstrates effect modification by sex using multiplicative interaction terms in multivariable linear regression models. Among 3143 participants (mean age, 50 years; 49% women), sex modified the association of BMI, waist circumference, and visceral adipose tissue with cardiovascular disease-related protein biomarkers (7 for BMI, 3 for waist circumference, and 23 for visceral adipose tissue, false discovery rate [FDR]-qint<0.05 for all). For example, higher BMI was associated with lower α1-microglobulin levels in men but not in women (ß, -0.113; SE, 0.028; P<0.001 in men versus ß, -0.007; SE, 0.024; P=0.78 in women). By contrast, higher BMI was associated with higher adipsin levels in men and women, but the association was more pronounced in women (ß, 0.287; SE, 0.023; P<0.001 in women versus ß, 0.189; SE, 0.026; P<0.001 in men). The associations of higher visceral adipose tissue with biomarkers representing adiposity, inflammation, and fibrosis were more pronounced in women versus men. We found that sex modified the associations of obesity and adipose traits with cardiovascular risk ascertained by cardiovascular disease-related biomarkers including markers of adiposity, inflammation, and fibrosis. These findings highlight potential biological pathways that may underlie some of the observed differences in obesity-related cardiovascular disease between women and men.

Cardiovascular Health Metrics of Spouses of Indian Women with a History of Gestational Diabetes and Diabetes in Pregnancy: Results from CHIP-F Study.

There are limited data on the prevalence of cardiovascular risk factors/diseases (diabetes, obesity, hypertension, and dyslipidemia) and their composite scores reflecting overall cardiovascular health among young (< 50years old) married couples. We have an established longitudinal prospective cohort of postpartum women with a history of hyperglycemia [pre-existing diabetes (PED; n = 101), overt diabetes in pregnancy (ODiP; n = 92), gestational diabetes (GDM; n = 643)], and normoglycemia (n = 183) in pregnancy and their spouses (n = 819). In this study, we report data from baseline cross-sectional evaluation of these 819 young couples regarding the burden of cardiovascular risk factors/diseases, their concordance and associations. The mean (SD) age was 33.5 (4.9) years for women and 36.9 (5.4) years for men, and the evaluation was performed at a median (IQR) postpartum interval of 30 (20-45) months. Diabetes, hypertension, obesity, and dyslipidemia were present in 25.0%, 6.9%, 25.6%, and 4.0% of women and 15.8%, 20.2%, 14.3%, and 8.2% of men, respectively. Among men, dysglycemia (diabetes/prediabetes) and adverse cardiovascular score (average/poor) showed a significant trend in progression according to the antenatal categories of their partner (highest in DIP, intermediate in GDM, and lowest in normoglycemia). The concordance was higher for adverse cardiovascular score (58.5%), overweight/obesity (48.7%), and dysglycemia (42.4%) compared to prehypertension/hypertension (29.2%) and hypercholesterolemia (8.2%). The odds ratios were significant for all associations evaluated, except for elevated blood pressure, being strongest (OR > 2.0) for overweight/obesity and adverse cardiovascular score. Nearly three in five young couples evaluated in the study showed concordance for adverse cardiovascular scores. The cardiovascular risk in men increased in a graded manner across the increasing severity of antenatal glycemic categories of their partners.

Effect of Combined Physical Exercise Training in Reducing Cardiovascular Risk Among Adults with Obesity: A Randomized Clinical Trial.

It is necessary to understand the relationship between different models of exercise periodization and the reduction of cardiovascular risk in adults with obesity. The aim of this study was to verify the effect of two periodization models of combined training on the cardiovascular risk of adults with obesity of both sexes. A randomized clinical trial was conducted with adults of both sexes with obesity. They were divided into three groups: control group (CG), non-periodized combined training group (NG), and combined training group with linear periodization (PG). The NG and PG groups underwent physical exercise training regimen for 16 weeks, in three weekly sessions of 60min each, with the volume and intensity equalized. Cardiovascular risk was measured by the overall Framingham risk score (FRS). Generalized estimation equations and individual responsiveness analyses were used, stratified by sex. A statistically significant reduction in FRS was observed only in men of the NG (pre: 2.50 ± 0.56; post: 0.50 ± 1.02; p-value = 0.001). There was no statistically significant intervention effect on the women's cardiovascular risk. It was found that, regardless of sex, subjects in the control group mostly presented results of increased cardiovascular risk. In contrast, those belonging to the exercise groups, if not reduced, at least stabilized the chances of suffering a cardiovascular event in the next ten years after 16 weeks of combined training. Sixteen weeks of non-periodized combined training were sufficient to reduce cardiovascular risk in men with obesity. Both periodization models were important to stabilize the risk of developing a cardiovascular disease in the next 10 years.

Abstract 14613: Sex Differences in Protein Biomarkers and Measures of Fat Distribution

Background: Sex differences in obesity and fat distribution have been well described and may explain differences in subsequent cardiovascular risk in men vs women. Underlying mechanisms are not fully elucidated and warrant further investigation. Objective: This study aims to examine sex differences in the associations of obesity and fat distribution measures with cardiovascular disease (CVD) protein biomarkers reflecting key pathways including inflammation, adiposity, fibrosis, and neurohormonal regulation. Methods: We measured 71 circulating protein biomarkers in 3,143 participants with available computed tomography measures of adiposity in the Framingham Heart Study. We examined whether sex modified the association of obesity (body mass index [BMI] and waist circumference [WC]) and fat distribution measures (visceral adipose tissue [VAT]) with protein biomarkers using multiplicative interaction terms in multivariable linear regression models. Sex-stratified analyses were performed as appropriate. Results: Among 3,143 participants (mean age 50 years, 48.7% women), we found that sex modified the association of BMI with 8 protein biomarkers including AGP-1, adipsin, IGFBP-1, IGFBP-2, ADM, KLKB1, MCP-1, and ucMGP (FDR-q int &lt; 0.05 for all, Figure 1 ). For example, BMI was associated with higher MCP-1 levels in women, but not in men (ß 0.132, SE 0.025, p &lt; 0.0001 in women vs ß 0.036, SE 0.028, p = 0.20 in men, FDR-q int 0.03). We found that sex also modified the association of WC and VAT with key CVD protein biomarkers including AGP-1 and A1M. Conclusions: We found that sex modified the association of obesity and adipose traits with cardiovascular risk as ascertained using biomarkers of CVD. These findings highlight potential biological pathways that may contribute to obesity-related cardiometabolic disease uniquely in men versus women.

The Beneficial Changes on Inflammatory and Endothelial Biomarkers Induced by Metabolic Surgery Decreases the Carotid Intima-Media Thickness in Men.

Obesity increases cardiovascular risk in men through several mechanisms. Among them, low-grade chronic inflammation and obesity-associated hypogonadism have been described. We aimed to study the effects of metabolic surgery on the carotid-intima media thickness through changes in inflammatory, endothelial biomarkers, and testosterone. We included 60 men; 20 submitted to laparoscopic Roux-en-Y gastric bypass (RYGB), 20 to sleeve gastrectomy (SG), and 20 to lifestyle modification (controls). Several inflammatory and endothelial biomarkers and total testosterone (TT) were measured at baseline and six months after surgery. Free testosterone (FT) was calculated, and carotid intima-media thickness (cIMT) was measured by ultrasonography. Compared to controls, cIMT decreased after surgery concomitantly with CRP, PAI-1, sICAM-1, and IL-18 (p < 0.01) and with an increase in sTWEAK (p = 0.027), with no differences between RYGB and SG. The increase in TT and FT after surgery correlated with the changes in cIMT (p = 0.010 and p = 0.038, respectively), but this association disappeared after multivariate analysis. Linear regression showed that sTWEAK (ß = -0.245, p = 0.039), PAI-1 (ß = 0.346, p = 0.005), and CRP (ß = 0.236, p = 0.049) were associated with the changes in cIMT (R2 = 0.267, F = 6.664, p = 0.001). In conclusion, both RYGB and SG induced improvements in inflammation and endothelial biomarkers that drove a decrease in cIMT compared to men with obesity who submitted to diet and exercise.

Sarcopenia is associated with cardiovascular risk in men with COPD, independent of adiposity

BackgroundSarcopenia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD), but its relationship with chronic obstructive pulmonary disease (COPD) has not been fully determined. This study is aimed to investigate the association between sarcopenia and risk for ASCVD in patients with COPD, independent of central obesity and fat mass.MethodsData regarding 704 men with COPD (mean age: 63.4 years) were extracted from the 2008 to 2011 Korean National Health and Nutrition Examination Surveys. Sarcopenia index and fat mass were assessed using dual-energy X-ray absorptiometry. Sarcopenia was defined according to the presence of sarcopenia index values < 1 standard deviation from the cutoff (0.774) among the study participants. ASCVD risk was evaluated using American College of Cardiology/American Heart Association guidelines. High probability of ASCVD was defined as ASCVD risk > 20%.ResultsThe quartile-stratified sarcopenia index was negatively associated with ASCVD risk (P < 0.001). ASCVD risk and prevalence of high ASCVD risk were significantly greater in sarcopenic participants than in non-sarcopenic participants, regardless of central obesity and fat mass (all P < 0.001). Multivariate regression analyses demonstrated an independent association between sarcopenia and ASCVD risk (estimated ± standard error = 3.63 ± 0.77%, P < 0.001) and high ASCVD risk (odds ratio [OR] = 2.32, 95% confidence interval [CI] 1.05–5.15, P = 0.039). Furthermore, sarcopenia was an independent factor for high ASCVD risk in participants with moderate to very severe airflow limitation (OR = 2.97, 95% CI 1.06–8.36, P < 0.001).ConclusionsSarcopenia was significantly associated with an increased risk for ASCVD in men with COPD, independent of central obesity and fat mass. High ASCVD risk was significantly associated with sarcopenia, particularly in participants with moderate to very severe airflow limitation.

MP48-04 EVALUATING CARDIOVASCULAR RISK IN MEN STARTING ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP48-04 EVALUATING CARDIOVASCULAR RISK IN MEN STARTING ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER Benjamin Lowentritt, Mark Fallick, Robert Dufour, Janis Pruett, Tao Jiang, Esmond Nwokeji, and Mitch Nagao Benjamin LowentrittBenjamin Lowentritt More articles by this author , Mark FallickMark Fallick More articles by this author , Robert DufourRobert Dufour More articles by this author , Janis PruettJanis Pruett More articles by this author , Tao JiangTao Jiang More articles by this author , Esmond NwokejiEsmond Nwokeji More articles by this author , and Mitch NagaoMitch Nagao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002619.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Androgen Deprivation Therapy (ADT) remains the foundation of advanced prostate cancer (PC) treatment. Since 2010, the FDA has required warnings for risk of cardiovascular (CV) disease in labeling of Gonadotropin-Releasing Hormone (GnRH) receptor agonists. In 2021, the American Heart Association recommended baseline assessment of CV risk in men starting ADT. However, optimal evaluation and management of CV risks remain to be defined. This real-world study evaluated men receiving ADT for PC to understand the association between CV risk factors and future events. METHODS: Using a US claims dataset, men diagnosed with PC and receiving ADT between 2010-2019 were identified. Index date was first ADT claim. Continuous enrollment of ≥12 pre- and ≥6 months post-index was required. Qualifying CV events were post-index hospital admission or emergency department visit with ICD-9/10 or CPT codes for either a cerebrovascular accident, coronary bypass graft, myocardial infarction, percutaneous coronary intervention, thrombosis, and/or unstable angina. A Cox regression model including pre-index covariates of age, CV history, radiation or PC surgery, or other metastatic drug therapy, and time on GnRH agonist was used to examine time to first CV event up to 3 years post-index. Additionally, CV risk based on comorbidities and CV-related treatments were evaluated by groupings of high, moderate, and low risk scores. RESULTS: Of 10,530 men with PC treated with ADT, 10,008 (95.5%) received a GnRH agonist during the 3-year observation period and 899 (8.98%) experienced a CV event post-index. The Cox model showed that CV history (HR=2.80, p <0.0001, [95% Confidence Interval (CI):2.37 - 3.31]), high and moderate CV risk (vs low) (1.94, p <0.0001, [1.54 – 2.45] and 1.40, p <0.0049, [1.11 – 1.76], respectively), other metastatic drug therapy (1.62, p <0.001, [1.22 – 2.16]), time on GnRH agonist (1.05, p <0.0001, [1.02 – 1.07]) and age (1.06, p=0.04, [1.00-1.12]) were associated with higher risk for a CV event. Radiation or PC surgery was associated with lower risk of a CV event (HR=0.69, p <0.001, [95% CI: 0.57 – 0.84]). CONCLUSIONS: In this study, CV history conveyed the highest risk of a new CV event up to 3 years after starting ADT treatment. Stratification by risk level was predictive of a CV event. Evaluation of these factors provides a framework for physicians starting men on ADT to identify those at greatest risk of CV events. Source of Funding: Myovant Sciences GmbH, in collaboration with Pfizer. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e821 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Lowentritt More articles by this author Mark Fallick More articles by this author Robert Dufour More articles by this author Janis Pruett More articles by this author Tao Jiang More articles by this author Esmond Nwokeji More articles by this author Mitch Nagao More articles by this author Expand All Advertisement PDF DownloadLoading ...

Time-varying testosterone level and risk of myocardial infarction and stroke among hypogonadal men: a longitudinal study in Germany

Background and objective: Findings on the association between testosterone and cardiovascular risk in men have been inconsistent. Previous studies investigated this association based on testosterone level measured at one single point in time (e.g., testosterone level at the baseline visit), which might not be relevant for the future cardiovascular events that occurred many years later, given the dynamic changes of testosterone level over time. Additionally, as compared to patients without prior cardiovascular history, those with prior cardiovascular events are more likely to have pathological changes in coronary or peripheral vasculature, and therefore more susceptible to cardiovascular events when exposed to risk factors. However, whether time-varying testosterone level affects differently between patients with prior cardiovascular events and those without is unknown. The objective of this study was to investigate the association between time-varying testosterone level and risks of myocardial infarction and stroke, and compared the associations stratified by patient’s prior cardiovascular event history. Material and methods: We used data of 376 hypogonadal men from a registry study in Germany with up to 11 years’ follow-up and applied Cox proportional hazards regression models to investigate the proposed association. Results: No association was found between baseline testosterone level and risks of myocardial infarction and stroke. When taking into account the changes of testosterone level over time and including testosterone as a time-varying covariate in the model, the adjusted hazard ratio (HR) for myocardial infarction associated with 1 nmol/L increase in testosterone level was 0.78 (95% CI: 0.64, 0.97); no association between time-varying testosterone level and stroke was found. The associations between testosterone level and cardiovascular risk were not different among patients with prior cardiovascular event history and those without. Conclusion: One baseline measurement of testosterone level may be insufficient to predict one’s future risk of cardiovascular events; regular monitoring of testosterone levels may be useful to assess the short-term cardiovascular risk in men.

Оцінка можливості розвитку цукрового діабету при різному рівні серцево-судиного ризику у чоловіків

В роботі оцінено можливості виникнення цукрового діабету (ЦД) 2-го типу у чоловіків із різним ризиком серцево-судинних захворювань, а також виявлені зв’язки між високим рівнем ризику розвитку ЦД 2-го типу та основними факторами серцево-судинного ризику. Респонденти (n = 152) були розподілені по групах серцево-судинного ризику без клінічних проявів серцево-судинних захворювань. У когорті чоловіків із різним рівнем серцево-судинного ризику за шкалою SCORE (Systematic COronary Risk Evaluation) низький ризик розвитку ЦД встановлений у 27 % випадків, помірно підвищений ризик — у 34,2 % осіб. Дуже високий ризик розвитку ЦД мали 38,9 % чоловіків. Можливість розвитку ЦД у найближчі 10 років, за опитувальником Finnish Diabetes Risk Score (FINDRISK), збільшується при наростанні серцево-судинного ризику. У групі низького/помірного серцево-судинного ризику — кожний десятий чоловік, у групі високого серцево-судинного ризику — кожний третій чоловік і в групі дуже високого серцево-судинного ризику — кожний другий чоловік має ризик розвитку ЦД. Збільшення прогнозованого ризику розвитку ЦД за шкалою FINDRISC асоціюється з наростанням індексу інсулінорезистентності (ІР). Серед осіб з ІР 3,9 % становлять пацієнти з низьким ризиком ЦД, 17,7 % належать до групи помірно підвищеного ризику розвитку ЦД. У той же час 78,4 % пацієнтів з ІР мають високий і дуже високий ризик розвитку ЦД.

Gender bias in ACS management

Abstract Background Cardiovascular disease is implicated in approximately 1 in every 3 deaths occurring in both women and men worldwide. Numerically, it is responsible for more female than male deaths each year, due largely to longer life expectancy amongst women. Consequently, guidelines from the major international bodies recommend against the use of sex as a discriminating factor in the evaluation of chest pain. Still there remains a public perception of excess cardiovascular risk in men, contributing to a delay in the seeking of medical attention by women with symptoms of acute coronary syndrome (ACS). We hypothesise the attendant concern that unconscious gender bias amongst clinicians influences the management of patients presenting with ACS from triage to invasive assessment and treatment. Aim To examine the relationship between patient gender and clinical management of ACS. Methods We conducted a retrospective cross sectional study of all patients in whom ACS was suspected during a year long period using the laboratory database of a tertiary cardiac referral centre in Ireland. In all patients for whom high sensitivity cardiac troponin T assay was ordered during the full calendar year 2019, age, sex and troponin level were recorded. We determined the likelihood of invasive angiography for male versus female patients after adjustment for age and troponin result. Results A total of 30,560 requests for high sensitivity cardiac troponin T (troponin) were made to the laboratory in the year ending December 2019. Excluding 464 for technical and sampling issues, 30,096 assays were included in the analysis. 43.84% (N=13,194) of samples were female and 56.16% (N=16,902) male. These samples were collected from 10,807 patients (5,294 female and 5,513 male). Median age was 58 for females and 57 for males. The upper limit of normal in our institution for serum troponin is &amp;lt;14ng/L and there is no adjustment for sex. 22.01% (N=1,165) of females and 33.39% (N=1,841) of males had at least one troponin level reported above the normal range. Of female patients with at least one troponin above the normal limit, 10.21% (N=119) underwent invasive coronary angiography compared to 18.52% (N=341) of males. Of females in whom all troponin results were normal, 5.84% (N=241) proceeded to invasive angiography versus 9.18% (N=337) of males. Conclusion Notwithstanding the limitations of lack of adjustment for risk profile, the results of this analysis demonstrate a higher rate of invasive angiography in males compared with females independently of troponin level. This is in keeping with previous research suggesting a gender gap in the approach of clinicians to ACS, and suggests an unconscious sex-based discrimination when making decisions around diagnosis and treatment. Education regarding the prevalence of coronary atherosclerosis, and interventions to alter the attitudes of clinicians, are some of the interventions suggested to close this gap. Funding Acknowledgement Type of funding sources: None.

Interleukin 6 trans-signalling and the risk of future cardiovascular events in men and women

ObjectivePro-inflammatory interleukin 6 (IL6) trans-signalling is associated with increased risk of cardiovascular events (CVEs). Whether this association exists for both sexes is, however, uncertain. Hence, we analysed the risk of...

Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study

BackgroundMen and women are labeled as obese on the basis of a body mass index (BMI) using the same criterion despite known differences in their fat distributions. Subcutaneous adipose tissue and visceral adipose tissue (VAT), as measured by computed tomography, are advanced measures of obesity that closely correlate with cardiometabolic risk independent of BMI. However, it remains unknown whether prognostic significance of anthropometric measures of adiposity versus VAT varies in men versus women.Methods and ResultsIn 3482 FHS (Framingham Heart Study) participants (48.1% women; mean age, 50.8±10.3 years), we tested the associations of computed tomography–based versus anthropometric measures of fat with cardiometabolic and cardiovascular disease (CVD) risk. Mean follow‐up was 12.7±2.1 years. In men, VAT, as compared with BMI, had a similar strength of association with incident cardiometabolic risk factors (eg, adjusted odds ratio [OR], 2.36 [95% CI, 1.84–3.04] versus 2.66 [95% CI, 2.04–3.47] for diabetes mellitus) and CVD events (eg, adjusted hazard ratio [HR], 1.32 [95% CI, 0.97–1.80] versus 1.74 [95% CI, 1.14–2.65] for CVD death). In women, however, VAT, when compared with BMI, conferred a markedly greater association with incident cardiometabolic risk factors (eg, adjusted OR, 4.51 [95% CI, 3.13–6.50] versus 2.33 [95% CI, 1.88–3.04] for diabetes mellitus) as well as CVD events (eg, adjusted HR, 1.85 [95% CI, 1.26–2.71] versus 1.19 [95% CI, 1.01–1.40] for CVD death).ConclusionsAnthropometric measures of obesity, including waist circumference and BMI, adequately capture VAT‐associated cardiometabolic and cardiovascular risk in men but not in women. In women, abdominal computed tomography–based VAT measures permit more precise assessment of obesity‐associated cardiometabolic and cardiovascular risk.

Insulin Resistance Indexes as Biomarkers of Lifetime Cardiovascular Risk among Adults from Peru.

Background Cardiovascular disease (CVD) is the most prevalent cause of death from disease and disability in the world. Reliable markers are needed to assess and reduce cardiovascular risk. This study aimed to determine if insulin resistance indexes, triglycerides to HDL-cholesterol ratio (TG/HDL-C), and triglyceride glucose index (TyG) are biomarkers for lifetime cardiovascular risk (CVR). Methods This analytical cross-sectional study was performed on health personnel from Huaycan Hospital in Peru. The QRISK model was used to measure lifetime CVR. The association and diagnostic accuracy for TyG calculated as Ln (TG (mg/dL) × glucose (mg/dL)/2) and TG/HDL-C ratio were determined using Poisson regression models and ROC curves with Youden index. Results In total, 291 adults (207 women and 84 men) were analyzed. In the adjusted Poisson models, each unit of TG/HDL-C increased 1.22-fold and 1.16-fold the probability of high lifetime CVR in men and women, respectively. However, each unit of TyG increased 1.98-fold in men and 3.25-fold in women the probability of high lifetime CVR. The optimal cutoff values of TG/HDL-C were 2.64 (AUC: 0.77), 3.90 (AUC: 0.80), and 2.64 (AUC: 0.74) for the overall population, men, and women, respectively. Likewise, the optimal cutoff values of TyG were 9.04 (AUC: 0.80), 8.95 (AUC: 0.79), and 9.04 (AUC: 0.80) for the overall population, men, and women, respectively. Conclusion TG/HDL-C and TyG presented a significant association with lifetime CVR. However, TyG presented a stronger association than TG/HDL-C. Both TG/HDL-C and TyG are shown to be reliable markers for CVR in adults.

Thirteen-year trends in cardiovascular risk in men and women with chronic coronary syndrome.

To examine combined and sex-specific temporal changes in risks of adverse cardiovascular events and coronary revascularization in patients with chronic coronary syndrome undergoing coronary angiography. We included all patients with stable angina pectoris and coronary artery disease examined by coronary angiography in Western Denmark from 2004 to 2016. Patients were stratified by examination year interval: 2004-2006, 2007-2009, 2010-2012, and 2013-2016. Outcomes were 2-year risk of myocardial infarction, ischaemic stroke, cardiac death, and all-cause death estimated by adjusted incidence rate ratios using patients examined in 2004-2006 as reference. A total of 29 471 patients were included, of whom 70% were men. The 2-year risk of myocardial infarction [2.8% vs. 1.9%, adjusted incidence rate ratio 0.65, 95% confidence interval (CI) 0.53-0.81], ischaemic stroke (1.8% vs. 1.1%, adjusted incidence rate ratio 0.48, 95% CI 0.37-0.64), cardiac death (2.1% vs. 0.9%, adjusted incidence rate ratio 0.38, 95% CI 0.29-0.51), and all-cause death (5.0% vs. 3.6%, adjusted incidence rate ratio 0.65, 95% CI 0.55-0.76) decreased from the first examination interval (2004-2006) to the last examination interval (2013-2016). Coronary revascularizations also decreased (percutaneous coronary intervention: 51.6% vs. 42.5%; coronary artery bypass grafting: 24.6% vs. 17.5%). Risk reductions were observed in both men and women, however, women had a lower absolute risk. The risk for adverse cardiovascular events decreased substantially in both men and women with chronic coronary syndrome from 2004 to 2016. These results most likely reflect the cumulative effect of improvements in the management of chronic coronary artery disease.

Association of Objectively Measured Timing of Physical Activity Bouts With Cardiovascular Health in Type 2 Diabetes

Moderate- to vigorous-intensity physical activity (MVPA) improves cardiovascular health. Few studies have examined MVPA timing. We examined the associations of timing of bout-related MVPA with cardiorespiratory fitness and cardiovascular risk in adults with type 2 diabetes. Baseline 7-day hip-worn accelerometry data from Look AHEAD participants (n = 2,153, 57% women) were analyzed to identify bout-related MVPA (≥3 METs/min for ≥10 min). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups on the basis of the time of day with the majority of bout-related MVPA (METs × min): ≥50% of bout-related MVPA during the same time window (morning, midday, afternoon, or evening), <50% of bout-related MVPA in any time category (mixed; the reference group), and ≤1 day with bout-related MVPA per week (inactive). Cardiorespiratory fitness was highly associated with timing of bout-related MVPA (P = 0.0005), independent of weekly bout-related MVPA volume and intensity. Importantly, this association varied by sex (P = 0.02). In men, the midday group had the lowest fitness (β = -0.46 [95% CI -0.87, -0.06]), while the mixed group in women was the least fit. Framingham risk score (FRS) was associated with timing of bout-related MVPA (P = 0.02), which also differed by sex (P = 0.0007). The male morning group had the highest 4-year FRS (2.18% [0.70, 3.65]), but no association was observed in women. Timing of bout-related MVPA is associated with cardiorespiratory fitness and cardiovascular risk in men with type 2 diabetes, independent of bout-related MVPA volume and intensity. Prospective studies are needed to determine the impacts of MVPA timing on cardiovascular health.

Erectile Dysfunction and Cardiovascular Risk in Men With Rheumatoid Arthritis: A Population-based Cohort Study.

Both erectile dysfunction (ED) and rheumatoid arthritis (RA) are associated with increased cardiovascular (CV) risk. It is unknown if these diagnoses are associated or if their combination confers additional CV risk. We aimed to define the incidence of ED in RA, and to determine if ED correlates with increased CV risk in RA. Medical information concerning RA, ED, and CV diagnoses for men with RA (n = 260) diagnosed in Olmsted County, Minnesota, and age-matched male comparators was extracted from a comprehensive medical record system. ED incidence was similar between the RA cohort and comparators (HR 0.80, 95% CI 0.55-1.16). In men with RA, ED diagnosis was associated with a trend toward an increase in peripheral arterial disease (HR 2.22, 95% CI 0.98-5.03) and a significantly decreased rate of myocardial infarction (HR 0.26, 95% CI 0.07-0.90), heart failure (HR 0.49, 95% CI 0.25-0.94), and death (HR 0.56; 95% CI 0.36-0.87). In men with RA and ED, phosphodiesterase-5 inhibitor use was associated with a decreased risk of death (HR 0.35, 95% CI 0.16-0.79), with a trending decreased risk of some CV diagnoses. Incidence of ED was not statistically increased in RA. Although patients with both RA and ED had a similar overall CV risk to those with RA alone, men with both RA and ED had decreased risk of heart failure, myocardial infarction, and death, as well as an increased risk of peripheral arterial disease. Further studies are needed to clarify these associations and their implications for pathogenesis and therapeutics.

Population with high cardiovascular risk receiving drug therapy and counseling: Brazil's status regarding the global goal, 2014-2015.

To estimate the prevalence of high cardiovascular risk (CVR), the proportion of people with high CVR who receive treatment and counseling, and to investigate the sociodemographic factors associated with this outcome, in Brazil. This was a cross-sectional study, using subsample data from the National Health Survey, collected via biochemical tests, in 2014-2015. Poisson regression was used. The proportion of high CVR in men was 11.2% (95%CI 9.6;12.9), and 10.4% (95%CI 9.2;11.8%) in women. In the group with high CVR, 68.8% (95%CI 63.7;73.4%) received counseling, 59.3% (95%CI 54.2;64.3%) received medication, and 55.6% (95%CI 50.4;60.7%) received both. In the multivariate analysis, receiving treatment and counseling was associated with being aged 50 years and over, and poor/very poor self-rated health (PR=1.26 - 95%CI 1.06;1.51). The proportion of people with high CVR who had received treatment and counseling was over 50%.

Abstract 14724: Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study

Background: The current clinical practice of defining obesity based on body mass index (BMI) does not capture differences in fat distribution between men and women. Visceral adipose tissue (VAT) as measured by computed tomography (CT), is an advanced measure of obesity that closely correlates with cardiometabolic risk independent of BMI. However, it remains unknown whether VAT adds additional prognostic significance over BMI in men or women. Methods: In participants of the Framingham Heart Study, we tested the associations of BMI and VAT with incident cardiometabolic events (diabetes, hypertension, low HDL, hypertriglyceridemia), and incident cardiovascular events and death. Mean follow-up was 12.7±2.1 years. Logistic and Cox-regression models were adjusted for age and smoking and adjusted odds and hazard ratios (adj. OR, adj. HR), are presented per 1-SD increase of each measure of body fat. Results: The study cohort comprised 3,482 participants (48.1% women, 50.8±10.3 years old). In men, VAT, as compared to BMI, had a similar strength of association with all cardiometabolic outcomes and incident cardiovascular disease (Figure). In women, however, VAT conferred a markedly greater association with incident cardiometabolic and cardiovascular disease compared to BMI (Figure). Conclusion and Relevance: BMI adequately captures VAT-associated cardiometabolic and cardiovascular risk in men but not in women. In women, abdominal CT-based VAT measures permit more precise assessment of obesity-associated cardiometabolic and cardiovascular risk.

Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex.

ResumoFundamento:A circunferência do pescoço (CP) é uma medida indireta do tecido adiposo subcutâneo da parte superior do corpo, apontada como um preditor independente de doenças cardiometabólicas.Objetivos:Verificar a associação entre a CP e o risco cardiovascular em 10 anos (risco de doença cardiovascular [DCV] em 10 anos) em homens e mulheres separadamente.Métodos:Análise seccional com inclusão de 13.920 participantes da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). A associação entre a CP (utilizada como variável contínua e agregada em quartis) e o risco de DCV em 10 anos, estimado pelo Framingham Global Risk Score (FGRS), foi investigada por meio de modelos lineares generalizados após ajustes por características sociodemográficas, comportamentos em saúde, índice de massa corporal e circunferência da cintura. O nível de significância estatístico adotado foi de 5%.Resultados:A média da CP foi de 39,5 cm (desvio-padrão [DP] de ± 3,6) nos homens e 34,0 cm (DP de ±2,9) nas mulheres. Após ajustes, o aumento de 1 cm na CP foi associado ao incremento de 3% (IC 95%: 1,02 a 1,03) e 5% (IC 95%: 1,04 a 1,06) na média aritmética do risco de DCV em homens e mulheres, respectivamente. No último quartil da CP, homens e mulheres apresentaram um incremento de 18% (IC 95%: 1,13 a 1,24) e 35% (IC 95%: 1,28 a 1,43), respectivamente, na média aritmética do risco de DCV após ajustes.Conclusões:Verificamos associação positiva e independente entre a CP e o risco de DCV em 10 anos. Resultados sugerem que a CP pode contribuir para a predição de risco cardiovascular além daquele observado pelas medidas antropométricas clássicas.

Borderline-low testosterone levels are associated with lower left ventricular wall thickness in firefighters: An exploratory analysis.

BackgroundLow endogenous testosterone has been associated with increased cardiovascular risk in men.ObjectivesTo determine the prevalence of low serum testosterone level (TT) in a cohort of male US career firefighters and to examine its relation with left ventricular wall thickness (LVWT).Materials and MethodsWe conducted a cross‐sectional study among 341 career firefighters, (age: 37.5 ± 10.3 years; BMI: 28.9 ± 4.5 kg/m2), who underwent an occupational medical screening examination. TT quartiles were determined, and LVWT distribution among them was plotted. Then, TT values were categorized as low (<264 ng/dL), borderline (264‐399 ng/dL), reference range (400‐916 ng/dL), and high (>916 ng/dL). To further investigate the association of mildly decreased TT on LVWT, we divided the borderline group into borderline‐low (264‐319 ng/dL) and borderline‐high (320‐399 ng/dL) ranges. LVWT values were classified as low LVWT when <0.6 cm. A multivariate model was used to compare LVWT, age, BMI, systolic blood pressure (SBP), and HbA1c among groups by TT values.ResultsThe prevalence of low TT was 10.6% and of borderline was 26.4%, while 58.7% had levels in the reference range. The low‐TT group was older and had higher BMI and SBP as compared to the reference group (P < .01). LVWT values were different among groups (P = .04) and significantly lower in firefighters with borderline‐low TT as compared to the reference group (P < .05). This finding also occurred within obese firefighters (P = .03). The borderline‐low group had a higher adjusted risk for a low LVWT as compared to the reference group [OR: 4.11 (95% CI: 1.79‐9.43)].DiscussionOur findings highlight the possible relationship between a mild reduction in testosterone levels (borderline) and lower LVWT.ConclusionsA high prevalence of subnormal TT levels (low and borderline: 37%) was observed in this relatively homogeneous cohort of career firefighters. Mildly decreased TT levels and lower LVWT might represent a preclinical condition and a window of opportunity for cardiovascular preventive interventions in firefighters.