Change In Cardiovascular Disease Risk Research Articles

Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003-2018.

Currently, it is still largely unknown whether the proportion of calcium intake at breakfast and dinner is associated with cardiovascular disease (CVD) in the general population. The aim of this study was to evaluate the association of dietary calcium intake at dinner versus breakfast with CVD in a nationally representative sample of US adults. The study population consisted of 36,164 US adults (including 4,040 CVD cases) from the NHANES 2003 to 2018. According to the ratio of dietary calcium intake at dinner and breakfast (Δ = dinner/breakfast), 36,164 participants were divided into five groups. After adjustment for a series of confounder factors, logistic regression analyses were performed to examine the association between Δ and CVD. Dietary substitution models were used to explore the changes in CVD risk when a 5% dietary calcium intake at dinner was substituted with dietary calcium intake at breakfast. Compared with participants in the lowest quintile, participants in the highest quintile were more likely to have CVD, with an adjusted OR of CVD of 1.16 (95% CI, 1.03 to 1.31). When the total calcium intake remained constant, replacing a 5% dietary calcium intake at dinner with dietary calcium intake at breakfast was associated with a 6% lower risk of CVD. Compared to the lowest quintile of Δ, participants in the highest quintile of Δ were likely to experience CVD in the general population. It is necessary to scientifically allocate dietary calcium intake at breakfast and dinner.

Circulating MicroRNA-19 and cardiovascular risk reduction in response to weight-loss diets

MicroRNA-19 (miR-19) plays a critical role in cardiac development and cardiovascular disease (CVD). We examined whether change in circulating miR-19 was associated with change in CVD risk during weight loss. This study included 509 participants with overweight or obesity from the 24-month weight-loss diet intervention study (the POUNDS Lost trial) and with available data on circulating miR-19a-3p and miR-19b-3p at baseline and 6 months. The primary outcome for this analysis was the change in atherosclerotic CVD (ASCVD) risk at 6 and 24 months, which estimates the 10-year probability of hard ASCVD events. Secondary outcomes were the changes in ASCVD risk score components. Circulating miR-19a-3p and miR-19b-3p levels significantly decreased during the initial 6-month dietary intervention period (P=0.008, 0.0004, respectively). We found that a greater decrease in miR-19a-3p or miR-19b-3p was related to a greater reduction in ASCVD risk (β[SE]=0.33 [0.13], P=0.01 for miR-19a-3p; β[SE]=0.3 [0.12], P=0.017 for miR-19b-3p) over 6 months, independent of concurrent weight loss. Moreover, we found significant interactions between change in miR-19 and sleep disturbance on change in ASCVD risk over 24 months of intervention (P interaction=0.01 and 0.008 for miR-19a-3p and miR-19b-3p, respectively). Participants with a greater decrease in miR-19 without sleep disturbance had a greater reduction of ASCVD risk than those with slight/moderate/great amounts of sleep disturbance. In addition, change in physical activity significantly modified the associations between change in miR-19 and change in ASCVD risk over 24 months (P interaction=0.006 and 0.004 for miR-19a-3p and miR-19b-3p, respectively). A greater decrease in miR-19 was significantly associated with a greater reduction in ASCVD risk among participants with an increase in physical activity, while non-significant inverse associations were observed among those without an increase in physical activity. In conclusion, decreased circulating miR-19 levels during dietary weight-loss interventions were related to a significant reduction in ASCVD risk, and these associations were more evident in people with no sleep disturbance or increase in physical activity. ClinicalTrials.gov NCT00072995.

Cardiovascular disease risk communication and prevention: a meta-analysis.

Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to investigate the impact of CVD risk communication on patient-perceived CVD risk and changes in CVD risk factors. PubMed, Embase, and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomized trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; disagreements were resolved by a third author. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines. Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6-12 months (mean difference = -0.27, 95% confidence interval = -0.45 to -0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients' intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group. In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients' self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.

The Impact of an Electronic Best Practice Advisory on Patients' Physical Activity and Cardiovascular Risk Profile.

Regular physical activity (PA) is a component of cardiovascular health and is associated with a lower risk of cardiovascular disease (CVD). However, only about half of US adults achieved the current PA recommendations. The study purpose was to implement PA counseling using a clinical decision support tool in a preventive cardiology clinic and to assess changes in CVD risk factors in a sample of patients enrolled over 12 weeks of PA monitoring. This intervention, piloted for 1 year, had 3 components embedded in the electronic health record: assessment of patients' PA, an electronic prompt for providers to counsel patients reporting low PA, and patient monitoring using a Fitbit. Cardiovascular disease risk factors included PA (self-report and Fitbit), body mass index, blood pressure, lipids, and cardiorespiratory fitness assessed with the 6-minute walk test. Depression and quality of life were also assessed. Paired t tests assessed changes in CVD risk. The sample who enrolled in the remote patient monitoring (n = 59) were primarily female (51%), White adults (76%) with a mean age of 61.13 ± 11.6 years. Self-reported PA significantly improved over 12 weeks (P = .005), but not Fitbit steps (P = .07). There was a significant improvement in cardiorespiratory fitness (469 ± 108 vs 494 ± 132 m, P = .0034), and 23 participants (42%) improved at least 25 m, signifying a clinically meaningful improvement. Only 4 participants were lost to follow-up over 12 weeks of monitoring. Patients may need more frequent reminders to be active after an initial counseling session, perhaps getting automated messages based on their step counts syncing to their electronic health record.

Achievements of primary prevention targets in individuals with high risk of cardiovascular disease: an 8-year follow-up of the Tromsø study.

AimsTo study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among individuals with high CVD risk in a general population.Methods and resultsWe followed 2524 women and men aged 40–79 years with high risk of CVD attending the population-based Tromsø study in 2007–08 (Tromsø6) to their participation in the next survey in 2015–16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol <5 mmol/L, 27.3% for LDL cholesterol <3 mmol/L, 43.4% for BP <140/90 (<135/85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement.ConclusionWe found an overall improvement in CVD risk factors among high-risk individuals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge.

A prospective study of the relationships between change in body composition and cardiovascular risk factors across the menopause.

Objective:Menopause increases the risk of cardiovascular disease (CVD) which in part has been attributed to the rise in cholesterol and blood pressure (BP). This study examined the hypothesis that menopausal changes in body composition and regional fat depots relate to the change in CVD risk factors.Methods:A prospective recall study was designed to capture premenopausal women to be re-examined soon after menopause. A total of 97 women from the Oxford Biobank underwent dual x-ray absorptiometry, blood biochemistry, and BP readings pre- and postmenopause.Results:Despite minimal changes in body weight over the 5.1 ± 0.9 year follow-up period, there was an increase in total fat mass and a decline in lean mass, where the proportional change of regional fat mass was the greatest for the visceral fat depot (+22%, P < 0.01). Plasma ApoB (+12%, P < 0.01) and C-reactive protein (+45%, P < 0.01) increased as did systolic (+7%, P < 0.001) and diastolic BP (+5%, P < 0.001). Plasma nonesterified fatty acids decreased (−20%, P < 0.05) which may reflect on a change in adipose tissue function across the menopause. PCSK-9 decreased (−26%, P < 0.01) which suggests a compensation for the postmenopausal reduction in low-density lipoprotein receptor activity. Using multilinear regression analyses the changes in ApoB and diastolic BP were associated with visceral fat mass change, but this association was lost when adjusted for total fat mass change.Conclusion:The increase in CVD risk factor burden across menopause may not be driven by changes in body composition, rather by functional changes in end organs such as adipose tissue and liver.

Predictors of change in cardiovascular disease risk and events following gastric bypass: a 7-year prospective multicenter study.

Change in short-term (i.e., 10-year) and lifetime risk of cardiovascular disease (CVD) following Roux-en-Y gastric bypass (RYGB) has significant heterogeneity. To identify predictors of change in CVD risk and cardiovascular events following RYGB. Between 2006-2009, 1625 adults without a history of CVD enrolled in a prospective cohort study and underwent RYGB at 1 of 10 U.S. hospitals. Participants were followed annually for a maximum of 7 years. Associations between presurgery characteristics (anthropometric, sociodemographic, physical and mental health, alcohol/drug use, eating behaviors) and 1) pre to postsurgery change in 10 year and lifetime atherosclerotic CVD (ASCVD) risk scores, respectively, and 2) having a CVD event (nonfatal myocardial infarction, stroke, ischemic heart disease, congestive heart failure, angina, percutaneous coronary intervention, coronary artery bypass grafting, or CVD-attributed death) as repeated measures (yr 1-7) were evaluated. Observational cohort study at ten hospitals throughout the United States. Presurgery factors independently associated with decreases in both 10-year and lifetime risk scores 1-7 years post-RYGB were higher CVD risk score, female sex, higher household income, and normal kidney function. Additionally, Black race and having diabetes were independently associated with decreases in 10-year risk, while not having diabetes and a higher (better) composite mental health score were independently related to decreases in lifetime risk. A lower (worse) presurgery composite physical health score was associated with a higher CVD event risk (RR = 1.68, per 10 points). This study identified multiple presurgery factors that characterize patients who may have more cardiovascular benefit from RYGB, and patients who might require additional support to improve their cardiovascular health.

Atherogenic Index of Plasma (AIP) a Tool to Assess Changes in Cardiovascular Disease Risk Post Laparoscopic Sleeve Gastrectomy.

Predictive indices like the atherogenic index of plasma (AIP) have been developed to estimate the risk of cardiovascular disease (CVD). Metabolic surgery is the most effective treatment for a rapid improvement of morbid obesity and its comorbidities such as type 2 diabetes (T2D) and CVD. A decreased reoccurrence of CVD after metabolic surgery has been reported by several studies. However, studies utilizing predictive indices for CVD risk in CVD-free morbid-obese patients who undertook laparoscopic sleeve gastrectomy (LSG) are lacking. Here, we use AIP as a tool to evaluate the improvement in CVD risk post-LSG in morbid-obese people who had no history of CVD. Method. We compared baseline, 6- and 12-month post-LSG score of AIP, vascular age, circulating biochemical markers related to CVD in two groups of BMI and age-matched morbid-obese participants with and without T2D. Results. At baseline, people with T2D had significantly higher AIP both, with morbid obesity (0.23 ± 0.06, p < 0.001) and normal weight (0.022 ± 0.05, p < 0.001) compared to their BMI-matched without T2D group. People with morbid obesity had low AIP (−0.083 ± 0.06). Vascular age was significantly higher in people with morbid obesity and T2D (65.8 ± 3.7year, p < 0.0001) compared to morbid obesity (37.9 ± 2.6 year). After one year, AIP was significantly reduced compared to baseline score in people with morbid obesity with/without T2D, respectively (−0.135 ± 0.07, p = 0.003; and −0.36 ± 0.04, p = 0.0002). Conclusion. Our data illuminates AIP as a reliable predictive index for CVD risk in morbid-obese people who had no history of CVD. Moreover, AIP accurately distinguishes between morbid obesity with T2D and morbid obesity and showed a rapid and significant reduction in CVD risk after LSG in people who had no history of CVD. This is a ClinicalTrials.gov registered trial (Reference NCT03038373).

Low Carbohydrate Diets in Men with Prostate Cancer May Reduce Risk of Cardiovascular Disease

Abstract Objectives Both weight loss and low-carbohydrate diets (LCDs) have been shown to slow prostate cancer (PC) growth in animal models. Given the significant weight loss and purported metabolic benefits of LCDs to lower insulin and glucose (two key cancer growth factors), there is growing interest in using them in cancer patients. However, critics point to potentially increased cardiovascular disease (CVD) as a major risk. The objective of this study is to examine the effect of an LCD on estimated CVD risk within the context of randomized trials of LCD in PC patients. Methods Carbohydrate and Prostate Cancer (CAPS) 1 and CAPS2 studies were randomized clinical trials testing 6 mo. of an LCD vs. control (asked to make no diet changes) in overweight PC patients. CAPS1 included 34 men starting androgen deprivation therapy (ADT) and tested whether LCD prevents insulin resistance. CAPS2 included 45 men with recurrent PC after primary treatment and tested whether LCD slows PC growth. Primary results have been presented. In this post-hoc analysis, we calculated 10-year risk of CVD at baseline, 3 mo., and 6 mo. in each study based on a CVD risk model developed from the Framingham Heart Study. This score accounts for age, diabetes, smoking, treated and untreated systolic blood pressure and BMI. Comparisons between arms were made using t-tests. A mixed model was used to test longitudinal changes in CVD risk combining data from both studies but adjusting for study. Results In CAPS1, the 10-year estimated CVD risk was unchanged from baseline to 6 mo. at 29% in controls but decreased from 31% to 23% in the LCD arm (p = 0.23). In CAPS2, CVD risk increased from 34% to 35% in controls but decreased from 32% to 28% in the LCD arm (p = 0.005). When data from the two studies were combined, the LCD was associated with a lower 10-year estimated CVD risk vs. control over the study period (p &amp;lt; 0.001). Conclusions Across two prospective randomized trials, an LCD in men with PC was associated with a lower estimated 10-year risk of CVD than control patients making no diet changes. These data support the safety of LCDs for men with PC. Given CVD is the number one cause of death in men with PC and pre-clinical data supporting anti-PC activity, further research on LCDs using long-term PC and CVD end-points is warranted. Funding Sources Atkins Foundation, American Urological Association, National Institute of Health/National Cancer Institute.

Change in predicted 10-year and lifetime cardiovascular disease risk after Roux-en-Y gastric bypass.

Long-term changes in cardiovascular disease (CVD) risk after bariatric surgery are not well characterized. To report sex-specific changes in CVD risk after Roux-en-Y gastric bypass surgery (RYGB). Observational cohort study at ten hospitals throughout the United States. Between 2006 and 2009, 1770 adults enrolled in a prospective cohort study underwent RYGB at 1 of 10 U.S. hospitals. Research assessments were conducted presurgery and annually postsurgery over 7 years. Sex specific-predicted 10-year and lifetime CVD risk were calculated using the Framingham10-year and lifetime risk scores, Framingham-body mass index, and atherosclerotic CVD scoring algorithms among participants with no history of CVD. Of 1566 eligible participants, 1234 (75.9%) with CVD risk determination pre- and postsurgery were included (1013 females, 221 males). Based on the Framingham10-year and lifetime risk scores, the percentage of females with predicted high (>20%) 10-year CVD risk declined from presurgery (6.5% [95% confidence interval: 6.7-7.5]) to 1 year postsurgery (1.0% [95% confidence interval: .8-1.2]; P < .001), then increased 1 to 7 years postsurgery (to 2.8% [95% confidence interval: 1.6-3.3]; P = .003), but was lower 7 years postsurgery versus presurgery (P < .001). Time trends for percentage of high-risk participants and mean CVD risk scores were similar for both sexes and other evaluated CVD risk scores. For example, among males mean lifetime atherosclerotic CVD score declined from presurgery to 1 year postsurgery, then increased 1 to 7 years postsurgery. However, there was a net decline from presurgery (P < .001). Among both females and males, predicted 10-year and lifetime CVD risk was substantially lower 7 years post RYGB than presurgery, suggesting RYGB surgery can lead to sustained improvements in short- and long-term CVD risk.

Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program

We aimed to examine whether a lifestyle intervention was effective in reducing cardiovascular disease (CVD) risk in individuals at high-risk of developing diabetes in a low- and middle-income setting. The Kerala Diabetes Prevention Program was evaluated by a cluster-randomized controlled trial (2013–2016) of 1007 individuals (aged 30–60 years) at high-risk for diabetes (Indian Diabetes Risk Score ≥ 60 and without diabetes) in Kerala state, India. Sixty polling areas in Kerala were randomized to intervention or control groups by an independent statistician using a computer-generated randomization sequence. Participants from 30 intervention communities received a 12-month structured peer-support lifestyle intervention program involving 15 group sessions and linked community activities, aimed at supporting and maintaining lifestyle change. The primary outcome for this analysis was the predicted 10-year CVD risk at two years, assessed using the Framingham Risk Score. The mean age at baseline was 46.0 (SD: 7.5) years, and 47.2% were women. Baseline 10-year CVD risk was similar between study groups. The follow-up rate at two years was 95.7%. The absolute risk reduction in predicted 10-year CVD risk between study groups was 0.69% (95% CI: 0.09% to 1.29%, p=0.024) at one year and 0.69% (95% CI: 0.10% to 1.29%, p=0.023) at two years. The favorable change in CVD risk with the intervention condition was mainly due to the reduction in tobacco use (change index: −0.25, 95% CI: −0.42 to −0.09). Our findings suggest that a community-based peer-support lifestyle intervention could reduce CVD risk in individuals at high-risk of developing diabetes in India. Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12611000262909.

Abstract P035: Habitual Aerobic Exercise-Induced Decrease in Circulating C1q Level is Associated With Reduction of Cardiovascular Diseases Risks in the Elderly

Introduction: Habitual aerobic exercise leads to reduction of arterial wall thickness and arterial stiffness with aging. Recently, C1q has been identified as a novel myokine, and the expression of muscle C1q mRNA increases with aging. Additionally, in vivo and in vitro studies, C1q induces proliferation of vascular smooth muscle cells. However, it remains unclear whether the secretion of myokines, C1q, TNF-alpha and IL-6 are related to the changes in cardiovascular disease risk by aging and regular exercise. PURPOSE: This study aimed to clarify whether serum C1q, TNF-alpha and IL-6 levels are associated with the changes in cardiovascular disease risks with aging and regular aerobic exercise. Methods: In a cross-sectional study, 127 healthy male and female subjects (18-81 years) were enrolled in this study. Subjects were divided into two groups; young (&lt;40 year) and middle-aged and older (≥40 year) groups. Serum C1q, TNF-alpha, IL-6 levels were determined by ELISA. Risks of cardiovascular disease were estimated by using carotid-femoral pulse wave velocity (cfPWV) and common carotid intima-media thickness (ccIMT). Additionally, in an intervention study, thirteen older male subjects were randomly divided into two groups: aerobic training group (AT: n=6) and a sedentary control group (Con: n=7). subjects in the AT group completed 8 wk of aerobic exercise training (60-70% peak oxygen uptake for 45 min, 3 days/wk). Results: In the cross-sectional study, serum C1q, TNF-alpha and IL-6 levels, cfPWV and ccIMT were significantly higher in middle-aged and older group as compared with young group (respectively p&lt;0.05). Positive correlations between cfPWV and serum C1q (r=0.41, p&lt;0.05), TNF-alpha (r=0.28, p&lt;0.05) or IL-6 (r=0.26, p&lt;0.05) levels were seen. Additionally, ccIMT was positively correlated with only serum C1q (r=0.67, p&lt;0.05). After adjusting for TNF-alpha and IL-6, the association between the serum C1q and cfPWV (ß=0.44, p&lt;0.05) or ccIMT (ß=0.83, p&lt;0.05) remained statistically significant. Additionally, in the intervention study, cfPWV and serum C1q level significantly decreased after AT intervention (each P&lt;0.05). Furthermore, the AT-induced change in serum C1q level was positively correlated with AT-induced change in cfPWV (r=0.65, P&lt;0.05) and ccIMT (r=0.59, P&lt;0.05). Conclusion: These results suggest that circulating C1q level may reflect the changes of arterial stiffness and thickness with aging and regular exercise, and the reduction of serum C1q level in response to regular aerobic exercise may contribute to the reduction in cardiovascular disease risks in the elderly.

Abstract P319: Salusin-α is a Novel Biomarker of Cardiovascular Disease Risk in Aging and Exercise Lifestyle: Cross-Sectional and Intervention Study

Introduction: A physically active lifestyle leads to reduced risks of cardiovascular disease events in the elderly. A level of circulating salusin-α is a novel biomarker of cardiovascular disease and is associated with increased arterial stiffness. Indeed, circulating levels of salusin-α are lower in patients with coronary arterial disease and hypertension compared to healthy subjects. However, it is unknown whether circulating salusin-α levels are decreased with advanced age and whether circulating salusin-α levels are associated with the reduced cardiovascular disease risks by exercise lifestyle. Hypothesis: We assessed the hypothesis that salusin-α is involved to the changes in cardiovascular disease risk by aging or exercise-promoting healthy lifestyle. Methods: In Experiment 1, 105 healthy subjects (20-80 years old) participated in a cross-sectional study. The subjects were divided into 2 groups: young (under 40 years, n=45) versus middle-age and older (over 40 years, n=60). In Experiment 2, 36 young subjects (young aerobic exercise training group; Young-AT: n=27 and control group; Young-Con: n=9) and 40 healthy middle-age and older subjects (middle-age and older aerobic exercise training group; Middle-age and older-AT: n=26 and control group; Middle-age and older-Con: n=14) volunteered to participate. Subjects in AT groups completed eight weeks of habitual aerobic exercise (60-70% peak oxygen uptake [VO2peak] for 45 min, 3 days/week). We measured serum salusin-α level, carotid-femoral pulse wave velocity (cfPWV), brachial artery systolic (SBP) and diastolic (DBP) blood pressures, common carotid intima-media thickness (ccIMT) and VO2peak. Results: In the cross-sectional study, cfPWV, SBP, DBP and ccIMT were significantly higher and serum salusin-α levels were significantly lower in the middle-age and older adults compared to young adults. Negative correlations were observed between serum salusin-α levels and age (r=–0.698, P&lt;0.01), SBP (r=–0.458, P&lt;0.01), DBP (r=–0.473, P&lt;0.01), cfPWV (r=–0.479, P&lt;0.01), and ccIMT (r=–0.577, P&lt;0.01). In the exercise intervention study, VO2peak and serum salusin-α levels were significantly increased, and cfPWV, SBP and DBP were significantly lowered in the Middle-age and older-AT group compared to the Con group (each P&lt;0.05). Additionally, significant negative correlations between exercise-induced changes in serum salusin-α levels and cfPWV (r=-0.597, P&lt;0.01), SBP (r=–0.591, P&lt;0.01), DBP (r=–0.442, P&lt;0.05) or ccIMT (r=–0.484, P&lt;0.05) were observed in the Middle-age and older-AT group. There were no significant differences for any of the parameters between Young-AT and Con groups. Conclusions: Changes in salusin-α levels may be a novel biomarker of the increase in cardiovascular disease risks with age and the decrease in cardiovascular disease risks with exercise lifestyle in healthy middle-age and older adults.

Changes in cardiovascular disease risk and risk factors among women with and without breast cancer

Cardiovascular disease (CVD) risk is an important health concern among survivors of breast cancer. However, few studies to date have examined whether trajectories of CVD risk and major risk factors are worse among women with a breast cancer diagnosis compared with those without. Changes in weight, body mass index, waist circumference, systolic blood pressure, and 10-year CVD risk were compared between women with (813 women) and without (1049 women) an incident breast cancer diagnosis while they were enrolled in the National Institute of Environmental Health Sciences Sister Study cohort. Blood pressure and adiposity measures were collected by trained examiners at an enrollment visit (≥1 year before breast cancer diagnosis) and a second home visit 4 to 11 years later (≥1 year after breast cancer diagnosis). The non-laboratory-based Framingham risk score, a measure of 10-year general CVD risk, was calculated at both the enrollment and second visits. All analyses were stratified by menopausal status at the time of enrollment. Women who were premenopausal at the time of enrollment experienced moderate increases in weight, waist circumference, systolic blood pressure, and CVD risk over the study period. Those who were postmenopausal at the time of enrollment demonstrated little change in weight, but were found to have increases in waist circumference, systolic blood pressure, and CVD risk. In both groups, changes over time did not differ significantly according to breast cancer status. Neither chemotherapy nor endocrine therapy were found to be associated with greater increases in CVD risk or risk factors. In the current study cohort, changes over time in CVD risk, adiposity measures, and blood pressure were similar between women who developed an incident breast cancer and those who did not.

Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: randomized clinical trial

BackgroundPhysical activity (PA) promotes cardiovascular health and health related quality of life (HRQoL), although the effect of that on blood pressure (BP) control has rarely been studied in hypertensive subjects. Our aim was to evaluate the effectiveness of a PA intervention programme on cardiovascular disease (CVD) risk, HRQoL and BP control in hypertensive subjects.MethodsA randomized clinical trial, with a PA intervention programme of 9 months duration, comprising a walking group of 120 min/week, supervised, and with socio-cultural activities. Participants were 207 hypertensive subjects (68.2 years, 76.8% women). PA (IPAQ-s), diet, CVD risk, BP, BMI, smoking, and HRQoL (SF-36) were assessed at baseline and at the end of the intervention. Changes in CVD risk and in HRQoL during the intervention was calculated (end-baseline score). Multivariate models were applied.ResultsIn multivariate models, the PA intervention programme, with no modification of the diet, decreased CVD risk (− 1.19 points) and the systolic BP (− 8.68 mmHg), and increased some areas of HRQoL (4.45 to 14.62 points). An increase in the percentage of subjects with controlled BP was observed by the PA programme itself (OR 5.395 to 5.785 according to multivariate models), and by the changes during the intervention in the decrease in CVD risk (OR 0.609) and in the increase in the HRQoL in physical component summary (OR 1.041), role physical (OR 1.010), and bodily pain (OR 1.014), independently of controlled BP at baseline.ConclusionsThis PA intervention programme improved cardiovascular health and HRQoL, and favoured BP control in primary care users with hypertension.Trial registrationClinicaltrials.gov ID NCT02767739; Trial registered on May 5th, 2016. Retrospectively registered.

Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks

BackgroundPeer support can improve health for patients with chronic conditions; however, evidence for disease prevention is less clear and peer recruitment strategies are not well described. This paper describes a study protocol to evaluate a peer support intervention to improve hypertension control and reduce cardiovascular disease (CVD) risk. Methods & research designTarget enrollment for this two-site study is n = 400. Eligibility criteria include Veterans enrolled in Veterans Health Administration (VHA) primary care with poorly controlled hypertension and one other cardiovascular disease risk (smoking, overweight/obesity, or hyperlipidemia) who live in census tracts with high rates of hypertension. Enrolled participants are randomized to a home-based peer delivered self-management intervention (5 home visits and 5 phone calls with a peer health coach) versus usual care. The primary outcome is a change in systolic blood pressure (SBP) and secondary outcomes include change in CVD risk and health care use. ResultsTrial results are pending and participant enrollment is ongoing. We recruited peer coaches from Veterans who lived in census tracks with the highest rates of hypertension. To recruit Veteran peer coaches, we asked primary care providers (n = 41) and team nurses (n = 35) to nominate patients who they thought would be a good fit for the peer coach position (based on successful self-management and health care navigation) (n = 73 nominated from 964 patients). We interviewed 12 Veterans and trained 5 peer coaches. ConclusionsResults of this trial will inform peer support programs targeted to provide community-based delivery of prevention services to patients in high-risk areas. Trial registrationClinicaltrial.gov identifier NCT02697422 Trial statusEnrollment for the randomized trial phase began in September 2017 and will be complete September 2019.

Change in cardiovascular disease risk after incident myocardial infarction: The Tromsø study 1994-2016

Change in cardiovascular disease risk after incident myocardial infarction: The Tromsø study 1994-2016

Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa

BackgroundChronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally.MethodsWe linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes.ResultsBoth income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors.ConclusionsOur findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

Abstract P458: Assessment of Cardiovascular Risk Reduction in Adults With Metabolic Syndrome or Type 2 Diabetes Treated With Lorcaserin: A Pooled Cohort Analysis

Introduction: Obesity is a risk factor for cardiovascular disease (CVD) and even modest weight loss can contribute to its reduction. Lorcaserin, a selective 5HT 2C receptor agonist, is indicated as an adjunct to a reduced-calorie diet and increased physical activity in adults with obesity (BMI≥30 kg/m 2 ) or overweight (BMI 27-29.9 kg/m 2 and at least 1 weight-related comorbidity). Using the 2013 ACC/AHA 10-year CVD risk assessment pooled cohort equation, we examined risk change in patients with metabolic syndrome or type 2 diabetes (T2DM) undergoing treatment with lorcaserin or placebo for weight loss. Methods: We identified patients with metabolic syndrome or T2DM in three randomized, double-blind studies (BLOOM, BLOSSOM, BLOOM-DM) examining the efficacy and safety of lorcaserin 10 mg bid (LOR) vs. placebo (PBO) at one year of treatment. Only patients with lipid values at baseline and one year were included. Once selected, patients were further stratified by weight loss at week 12 of treatment (≥5% vs. &lt;5%). A CVD risk score &gt;5% was classified as high risk, and a 0.5% change in risk over one year was defined as clinically relevant. CVD risk reduction by cohorts, overall and by gender, was compared. Results: Overall, 43% LOR (n=449/1056) and 20% PBO (n=207/1041) patients had &gt; 5% weight reduction at week 12 (p&lt;0.05). Baseline CVD risk was 5.43% and 5.14% in the LOR and PBO cohorts, respectively. At one year, PBO-corrected change in CVD risk compared to LOR treatment was -0.21% (95% CI 0.02, 0.04, p=0.03; LOR -0.55% vs -0.3% PBO) overall and -0.56% (95% CI 0.12, 0.99, p=0.012; LOR -1.08% vs PBO -0.41%) in men. CVD risk in women was &lt;5% at baseline, with no significant change seen at one year. For 12-week responders, both LOR and PBO had a clinically relevant change in CVD risk overall (-0.81% and -0.79%) and for men (-1.71% vs -1.02%). For patients with &lt;5% weight loss, only men in the LOR cohort showed clinically relevant CVD risk changes (-0.57% vs -0.26%, respectively). Conclusion: The analysis suggests that patients with overweight or obesity and metabolic syndrome/T2DM at risk for CVD, and treated with LOR, experienced a significant CVD risk reduction at one year vs PBO, most notably among men. LOR can effectively reduce weight, which is associated with improvements in CVD risk.

Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance. This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved. This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.