Coronary Heart Disease Risk Profile Research Articles

Genetically Determined Reproductive Aging and Coronary Heart Disease: A Bidirectional 2-sample Mendelian Randomization.

BackgroundAccelerated reproductive aging, in women indicated by early natural menopause, is associated with increased coronary heart disease (CHD) risk in observational studies. Conversely, an adverse CHD risk profile has been suggested to accelerate menopause.ObjectivesTo study the direction and evidence for causality of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors in a bidirectional Mendelian randomization (MR) approach, using age at natural menopause (ANM) genetic variants as a measure for genetically determined reproductive aging in women. We also studied the association of these variants with CHD risk (factors) in men.DesignTwo-sample MR, using both cohort data as well as summary statistics, with 4 methods: simple and weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression.ParticipantsData from EPIC-CVD and summary statistics from UK Biobank and publicly available genome-wide association studies were pooled for the different analyses.Main Outcome MeasuresCHD, CHD risk factors, and ANM.ResultsAcross different methods of MR, no association was found between genetically determined reproductive aging and CHD risk in women (relative risk estimateIVW = 0.99; 95% confidence interval (CI), 0.97-1.01), or any of the CHD risk factors. Similarly, no associations were found in men. Neither did the reversed analyses show evidence for an association between CHD (risk factors) and reproductive aging.ConclusionGenetically determined reproductive aging is not causally associated with CHD risk (factors) in women, nor were the genetic variants associated in men. We found no evidence for a reverse association in a combined sample of women and men.

Oral Condition and Incident Coronary Heart Disease: A Clustering Analysis

Poor oral health has been linked to coronary heart disease (CHD). Clustering clinical oral conditions routinely recorded in adults may identify their CHD risk profile. Participants from the Paris Prospective Study 3 received, between 2008 and 2012, a baseline routine full-mouth clinical examination and an extensive physical examination and were thereafter followed up every 2 y until September 2020. Three axes defined oral health conditions: 1) healthy, missing, filled, and decayed teeth; 2) masticatory capacity denoted by functional masticatory units; and 3) gingival inflammation and dental plaque. Hierarchical cluster analysis was performed with multivariate Cox proportional hazards regression models and adjusted for age, sex, smoking, body mass index, education, deprivation (EPICES score; Evaluation of Deprivation and Inequalities in Health Examination Centres), hypertension, type 2 diabetes, LDL and HDL serum cholesterol (low- and high-density lipoprotein), triglycerides, lipid-lowering medications, NT-proBNP and IL-6 serum level. A sample of 5,294 participants (age, 50 to 75 y; 37.10% women) were included in the study. Cluster analysis identified 3,688 (69.66%) participants with optimal oral health and preserved masticatory capacity (cluster 1), 1,356 (25.61%) with moderate oral health and moderately impaired masticatory capacity (cluster 2), and 250 (4.72%) with poor oral health and severely impaired masticatory capacity (cluster 3). After a median follow-up of 8.32 y (interquartile range, 8.00 to 10.05), 128 nonfatal incident CHD events occurred. As compared with cluster 1, the risk of CHD progressively increased from cluster 2 (hazard ratio, 1.45; 95% CI, 0.98 to 2.15) to cluster 3 (hazard ratio, 2.47; 95% CI, 1.34 to 4.57; P < 0.05 for trend). To conclude, middle-aged individuals with poor oral health and severely impaired masticatory capacity have more than twice the risk of incident CHD than those with optimal oral health and preserved masticatory capacity (ClinicalTrials.gov NCT00741728).

Functional principal component based landmark analysis for the effects of longitudinal cholesterol profiles on the risk of coronary heart disease.

Patients' longitudinal biomarker changing patterns are crucial factors for their disease progression. In this research, we apply functional principal component analysis techniques to extract these changing patterns and use them as predictors in landmark models for dynamic prediction. The time-varying effects of risk factors along a sequence of landmark times are smoothed by a supermodel to borrow information from neighbor time intervals. This results in more stable estimation and more clear demonstration of the time-varying effects. Compared with the traditional landmark analysis, simulation studies show our proposed approach results in lower prediction error rates and higher area under receiver operating characteristic curve (AUC) values, which indicate better ability to discriminate between subjects with different risk levels. We apply our method to data from the Framingham Heart Study, using longitudinal total cholesterol (TC) levels to predict future coronary heart disease (CHD) risk profiles. Our approach not only obtains the overall trend of biomarker-related risk profiles, but also reveals different risk patterns that are not available from the traditional landmark analyses. Our results show that high cholesterol levels during young ages are more harmful than those in old ages. This demonstrates the importance of analyzing the age-dependent effects of TC on CHD risk.

Re-examining the relationship between alcohol consumption and coronary heart disease with a new lens

Moderate alcohol consumption has been related to lower risk of coronary heart disease (CHD) in the literature. To examine whether alcohol drinking during the past 12 months and heaviest drinking period were differentially associated with the risk of CHD, we designed a case-control study using a population-based health survey of U.S. adults conducted from 2012 to 2013. Respondents who reported to have doctor-ascertained CHD served as cases (n = 1671), and those free of CHD and other alcohol-related health conditions served as controls (n = 17,629) in logistic regressions. Sex-specific quartiles of average daily ethanol intake were ascertained and calculated for the past 12 months and during the period of heaviest lifetime drinking. We further split current drinkers into reducers and non-reducers (past 12 months relative to the heaviest drinking period) to examine CHD risk profiles in association with the 12-month drinking level. Current-drinker reducers (AOR, 95% CI = 1.57 [1.10–2.27] for men; AOR, 95% CI = 1.33 [1.02–1.72] for women) and former drinkers (AOR, 95% CI = 2.06 [1.43–2.97] for men; AOR, 95% CI = 1.51 [1.19–1.92] for women) more often had CHD than lifetime abstainers. Male heavy drinkers during the heaviest drinking period (AOR, 95% CI = 2.25 [1.52–3.32]) were more likely to manifest CHD than lifetime abstainers. In addition, individuals with diagnosed CHD were significantly more likely to have reduced drinking in the past. A change in alcohol consumption over the life course among former and current drinkers may distort the true alcohol-CHD relationship.

Preliminary study of the relationship between promoter methylation of the ANGPTL2 gene and coronary heart disease.

Coronary heart disease (CHD) is primarily caused by atherosclerosis of coronary arteries. It is largely an inflammatory disease of the vascular wall. The inflammation is related to DNA methylation. Angiopoietin-like protein 2 (ANGPTL2) has various functions in several chronic inflammatory diseases. Macrophage-derived ANGPTL2 was reported to accelerate CHD development. It is reported that DNA hypomethylation in the promoter region of ANGPTL2 gene was associated with acute coronary syndrome (ACS), a type of CHD. Our objective was to explore the correlation between promoter methylation of the ANGPTL2 gene and CHD, and to investigate the association between methylation status and clinical characteristics of CHD patients. Firstly, we collected 122 CHD patients and 58 non-CHD participants from Han Chinese population and purified the peripheral blood DNA. The purified DNA was subjected to bisulfite modification. After bisulfite conversion, the target DNA locus was amplified using polymerase chain reaction (PCR), and the PCR products were measured by pyrosequencing. Finally, the methylation level was calculated according to the sequencing result, and the data were analyzed using xx software. CHD patients had a relatively lower methylation levels (P50: 7.67% [P25: 6.22%, P75: 10.43%]) in the ANGPTL2 promoter region than did controls (P50: 8.25% [P25: 5.46%, P75: 17.98%], P=0.001), indicating an association between ANGPTL2 promoter methylation and CHD (OR: 0.890; 95% CI, 0.832-0.953; adjusted P=0.001). A breakdown analysis by gender showed that ANGPTL2 promoter methylation was associated with CHD in females (adjusted P=0.002) but not in males (adjusted P=0.404). We found no correlation between gene methylation and other clinical characteristics. The present work provides evidence to support an association between ANGPTL2 promoter DNA methylation status and the risk profile of CHD in females. Our data indicated that in females, promoter DNA hypomethylation of the ANGPTL2 gene is associated with an increased risk of CHD.

Modifiable Coronary Heart Disease Risk Factors Trends in Urban Black South African Females and the Implications for Health Promotion Interventions

BACKGROUND: Multiple risk factors can contribute to the development of coronary heart disease (CHD) in an individual, yet any change in the modifiable CHD risk status of Black South African females in recent times is unknown.AIM: The researcher aimed to establish the current CHD risk status of urban Black African females and to report on any trends over a 10-year period with the purpose to direct health promotion programs.METHODS: Data from 62 urban Black females (Mean age 32.4 ± 8.5 years) in 2006 was paired for age with that of 67 women (Mean age 32.0 ± 9.0 years) in 2016. The modifiable CHD risk factors assessed were cigarette smoking, sedentary lifestyle, obesity, hypertension, and hypercholesterolemia.RESULTS: Physical inactivity (72.6% of the sample in 2006 vs. 75.8% in 2016) and obesity (42% in 2006 vs. 38.8% in 2016) were the top-ranked risk factors for CHD with the pattern unchanged in 2016. Significantly fewer participants (4.5% vs. 16.6%; p &lt; 0.05) were hypertensive and significantly more women had hypercholesterolemia (5.6% vs. 23.9%; p &lt; 0.05) in 2016. The multiple CHD risk profile showed that 42.4% had at least one CHD risk factor (an increase of 25%) and significantly fewer (27.3% vs. 45.2%; p &lt; 0.05) had two CHD risk factors in 2016.CONCLUSION: A sedentary lifestyle and obesity were the highest CHD risk factors. Also, the multiple CHD risk profile of Black African women changed over a period of 10 years from higher to lower and normal risk. Health promotion strategies must be directed towards weight reduction, increasing physical activity levels and be tailored for the population for which the health promotion programs have been designed.

Correlation of different Framinghan vascular risk factors and cognitive impairment

Objective To evaluate the relationship between different Framinghan vascular risk factor and cognitive impairment in the middle-aged and elderly. Methods 71 participants from Physical Examination Center, Zhongnan Hospital of Wuhan University were consecutively recruited from March 2016 to May 2016. Framingham Cardiovascular Disease Risk Profile (FCVDRP), Framingham Stroke Risk Profile (FSRP) and Framingham Coronary Heart Disease Risk Profile (FCHDRP) were respectively used to evaluate the vascular burden of the participants. Mini-mental state examination (MMSE) and digital sign conversion test (DST) were used to evaluate the cognitive function of the participants. Partial correlation analysis was used to investigate the correlation between FCVDRP, FSRP and FCHDRP scoring methods and cognitive function. Results (1)After adjusting for education years, with the increase of vascular burden scores, the scores of MMSE (FCVDRP: low-risk group (28.29±1.38), mid-risk group(27.40±1.73), high-risk group (26.72±1.93); FSRP: low-risk group (28.00±1.60), mid-risk group (26.26±2.46), high-risk group (27.2±2.04); FCHDRP: low-risk group (27.74±1.73), mid-risk group (27.46±2.00), high-risk group (27.18±1.59)) and DST (FCVDRP: low-risk group (29.24±5.54), mid-risk group (27.40±1.73), high-risk group (26.72±6.76); FSRP: low-risk group (30.09±5.61), mid-risk group (25.11±7.55), high-risk group (23.53±5.60); FCHDRP: low-risk group (30.37±6.41), mid-risk group (25.46±6.76), high-risk group (26.82±5.99)) were significantly decreased(all P<0.05). (2)The results of partial correlations analysis showed that the scores of FSRP were significantly correlated with MMSE (r=-0.249) and DST (r=-0.291)(both P<0.05). Conclusion Aggregation of vascular risks factors may aggravate cognitive impairment in middle-aged and elderly people. Compared to FCVDRP and FCHDRP, FSRP assessment may be more significantly associated with vascular cognitive impairment. Key words: Vascular risk factors; Cognitive function; Framinghan vascular risk profile

Coronary Heart Disease risk profile among women attending Tertiary Care Hospital in Southern Karnataka, India

Background: Present study was conducted to assess the risk factors of CHD in women who had undergone Coronary Angiography for CHD evaluation. Objectives of the study were to assess the CHD Risk profile among women attending Tertiary Care Hospital at Mysore city and to enlist the clinical presentation of women admitted to tertiary care Hospital. Settings and Design: Hospital based cross sectional study. Methods: All the women who were admitted to the Department of Cardiology from April 2015 to January 2016 were interviewed using pre structured proforma. Details of the female patients who had undergone Angiography from September 2013 to March 2015 were also collected from Medical Record Section of the Hospital. Statistical Analysis: Proportion and mean were used for relevant univariate analysis and significance of association was tested using appropriate tests of significance. Results: 17% of women were known cases of CHD. 87.4% of women were admitted with the symptom of chest pain. 44% of women who presented with IHD belonged to normal and underweight BMI category. Among the clinically suspected or diagnosed to be cases of CHD, 75% had blocks in their coronaries. Single artery block (29.7%) and triple artery block (22.5%) were predominant. Left anterior descending artery had significant block (&gt;70%) in 36% of women. Left circumflex artery and right coronary arteries showed significant blocks in 26% and 22.5% participants. Conclusions: Earlier age of presentation, higher proportion of coronary blocks in majority of study women belonging to normal or underweight BMI category are alarms of changing pattern of CHD in Indian women.

Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study.

Dyslipidemia, hypertension, inflammation, and coronary heart disease (CHD) are adverse events in human immunodeficiency virus (HIV)-infected patients even if they are receiving antiretroviral therapy (ART). Yet, data on CHD risk induced by HIV or ART in sub-Saharan Africa are limited. The aim of this longitudinal study was to describe changes in CHD risk profiles measured by lipids, inflammatory markers, and Framingham scores among HIV-positive patients previously reported from Harare, Zimbabwe. Patients were grouped into ART-experienced patients (n=147) and ART-naïve patients (n=23) and followed up for 9 months. Generalized least squares random-effects modeling was applied to explain changes in total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC/HDL ratio, myeloperoxidase, highly sensitive C-reactive protein, and Framingham scores over the 9-month period. Independent variables included age, sex, monthly earning, body mass index, systolic blood pressure (SBP), diastolic blood pressure, duration of HIV diagnosis, duration of ART, viral load, and CD4 count. In ART-experienced patients, there was a substantial decrease in TC over time, ART-negative patients showed a significant increase in TC and HDL over time, and the increase in TC was associated with high viral load and low duration of HIV diagnosis, while increase in HDL was associated with young age, low body mass index, and low SBP. Framingham risk scores increased with time in ART-positive patients, and the change was positively correlated with age, sex, high SBP, and low HDL. There was no association between calculated CHD risk (TC/HDL ratio or Framingham score) and changes in levels of inflammatory markers (myeloperoxidase and highly sensitive C-reactive protein) in any of the patient groups. In conclusion, ART-experienced HIV-positive patients show changes in lipid values over time that makes it necessary to include lipid monitoring in order to reduce any risk of long-term CHD.

Factors Affecting Adherence to Statins in Hypercholesterolemic Kuwaiti Patients: A Cross-Sectional Study

Objective: This study examined statin adherence amongst Kuwaiti hypercholesterolemic patients in order to identify factors associated with poor adherence and to determine whether or not an association exists between statin adherence and the risk profile of coronary heart disease (CHD). Subjects and Methods: Two hundred hypercholesterolemic patients (30-69 years of age) were recruited from Kuwaiti primary healthcare clinics and interviewed about demographic characteristics, pre-existing self-reported medical conditions and prescribed medications. The Morisky Medication Adherence Scale was used to assess statin adherence (a self-reported, medication-adherence questionnaire divided into 3 levels, with a score of 8 denoting high adherence, 6 to <8 denoting medium adherence and <6 denoting low adherence). Data regarding anthropometric, psychological and serum risk factors were collected using 2 additional questionnaires, laboratory tests and bioelectrical impedance scales. Binary logistic regression was used to determine predictors of adherence and general linear modelling was used to test relationships between continuous outcomes and statin adherence. Results: Of the 200 participants, 117 (58.5%) reported low adherence, 83 (41.5%) reported medium adherence and no patients (0%) scored high adherence. Younger patients (aged 30-50 years) had lower adherence than older patients (>50 years) [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01-1.09] for every extra year; p < 0.01). Those without diabetes, i.e. 113 (56.5%), were less likely to report medium adherence than those with diabetes (OR 0.42; 95% CI 0.23-0.75; p < 0.01). Low statin adherence was associated with higher levels of plasma cholesterol (p < 0.001) and low-density lipoprotein (p < 0.01). Conclusion: In this study, there was a high prevalence of low statin adherence, especially among younger patients with fewer concomitant diseases. The results indicated an inverse relationship between statin adherence and CHD risk profile.

Hypertriglyceridemia: A simple approach to identify insulin resistance and enhanced cardio-metabolic risk in patients with prediabetes

AimsPrediabetes (PreDM) is a metabolically heterogeneous condition, differing in degree of insulin resistance and risk of type 2 diabetes mellitus and coronary heart disease (CHD). This study was initiated to evaluate the hypothesis that a fasting plasma triglyceride (TG) concentration ⩾1.7mmol/L can aid in identifying the subset of individuals with PreDM who are most insulin resistant and at greatest risk to develop CHD as well as type 2 diabetes mellitus. MethodsIn this cross-sectional study, measurements were made of: (1) steady-state plasma glucose (SSPG) concentration during the insulin suppression test to ascertain degree of insulin resistance and (2) conventional CHD risk factors in 587 apparently healthy individuals with normal fasting plasma glucose (NFG, n=370) or PreDM (n=217). ResultsSubjects with PreDM were significantly (P<0.001) more insulin resistant (higher SSPG concentrations) and had a more adverse CHD risk profile than those with NFG. A TG concentration ⩾1.7mmol/L identified a subset of individuals with PreDM (38%) who had a higher mean SSPG concentration (11.3±3.5mmol/L vs. 9.3±3.9mmol/L, P<0.001), were more likely to be insulin resistant (66% vs. 39%, P<0.001), and had a more adverse CHD risk factor profile. ConclusionsMeasurement of fasting TG concentration in individuals with PreDM may provide a simple clinical approach to identify those who are insulin resistant, at enhanced risk of CHD, and more likely to develop type 2 diabetes mellitus.

Association of Coronary Heart Disease Risk and Lipid Profile in Indian Women With Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) has been one of the major public health problems in India. Women with PCOS are often assumed, a priori , to be at increased risk for cardiovascular disease, given the high prevalence of the metabolic syndrome X among them. Lipoprotein (a) (Lp(a)) is an risk factor for development of atherosclerosis and along with dyslipidemia may add to cardiovascular risk. The aim of the study was to know the lipid profile variation in Indian women with PCOS. Methods: This cross-sectional study was conducted in West Bengal state, India. The subjects enrolled for the study included 180 women with PCOS who were compared with 95 healthy women of the control group; all of them were age and weight matched. Samples were taken after overnight fasting, and then serum lipid levels were analyzed. Results: The mean age of subjects was 28.71 ± 4.12 years in the PCOS group and 30.14 ± 3.29 years in the control group. The lipid profile parameters were comparable between patients and control subjects. There was a statistically significant difference in the Lp(a) levels between patients with PCOS and normal controls (P ≤ 0.0001). There were statistically significant increased levels of total cholesterol, very low-density lipoprotein and low-density lipoprotein cholesterol in PCOS group when compared with the control group (P < 0.05) and decreased level of high-density lipoprotein cholesterol. Conclusion: The changed lipid profile levels may contribute to increased cardiovascular risk in PCOS patients. J Clin Gynecol Obstet. 2016;5(1):23-26 doi: http://dx.doi.org/10.14740/jcgo375w

Association of Coronary Heart Disease Risk and Lipid Profile in Indian Women With Polycystic Ovarian Syndrome

Association of Coronary Heart Disease Risk and Lipid Profile in Indian Women With Polycystic Ovarian Syndrome

Significantly Greater Progression of Intima-Media Thickness of the Carotid Artery in Japanese American Men Than in White Men: The ERA JUMP Study

BackgroundAlthough a westernized lifestyle was associated with increased coronary heart disease (CHD), morbidity, and mortality in first- and second-generation Japanese Americans, CHD mortality was reported to be lower in this population than in whites. The risk profile of CHD for third- and fourth-generation Japanese Americans is not known. We compared the progression of carotid intima-media thickness (CIMT) between third- or fourth-generation Japanese Americans and whites. MethodsPopulation-based samples of 473 men (Japanese Americans, 227; whites, 246) aged 40-49 years at baseline and free of clinical cardiovascular disease were examined for CIMT at baseline (2004-2007) and follow-up (2007-2013). CIMT was determined centrally at the University of Pittsburgh, Pittsburgh, Pennsylvania. Analysis of covariance was used to compare annualized progression of CIMT between Japanese Americans and whites, adjusting for cardiovascular risk factors and baseline CIMT. ResultsProgression of CIMT was significantly greater in Japanese Americans than in whites both before and after adjusting for covariates: mean, 14.4 μm/y; 95% confidence interval [CI],12.3-16.4 vs 9.8 μm/y; 95% CI, 7.8-11.7; P < 0.05 and 15.1 μm/y; 95% CI, 13.1-17.1 vs 9.1 μm/y; 95% CI, 7.2-11.0; P < 0.05, respectively. Age, total cholesterol/high-density lipoprotein cholesterol, and diabetes in Japanese Americans and age, hypertension, and lipid medication in whites were significantly associated with progression of CIMT. ConclusionsThe significantly greater progression of CIMT in Japanese Americans than in whites might suggest a higher future burden of CHD in Japanese Americans than in whites. The current study identifies Japanese Americans as an important target group for prevention of CHD. Future research assessing carotid plaque in addition to CIMT is warranted.

Are different vascular risk scores calculated at midlife uniformly associated with subsequent poor cognitive performance?

BackgroundResearch concerning the link between individual vascular risk factors and cognition is plentiful but few studies have investigated the role of global vascular risk. We examined the cross-time associations of several vascular risk scores with cognitive performance during aging. MethodsUsing data from the French SU.VI.MAX cohort, we studied a sample of 3061 participants. Framingham coronary heart disease, cardiovascular and stroke risk profiles were computed using baseline data (1994–1996). Cognitive performance was assessed after a mean of 13 years via a battery of six validated instruments. Principal component analysis identified scores for verbal memory and working memory. Associations between risk profiles (as continuous variables and in quartiles (Q)) and subsequent poor performance (defined as cognitive score ≤10th percentile) were examined via logistic regression (odds ratios, 95% CI) and analysis of covariance. ResultsAll continuous-scale Framingham risk scores assessed at midlife were inversely and uniformly associated with subsequent poor global cognitive performance, and especially in terms of verbal memory. Considering risk score Q, higher Q were associated with poorer performance in verbal memory: The fully-adjusted odds ratios (95% CI), comparing Q4 versus Q1, were 2.84 (1.70, 4.75), 2.31 (1.43, 3.73) and 1.77 (1.13, 2.76) for Framingham coronary heart disease, cardiovascular and stroke risk profiles, respectively. Similar findings were observed when modeling cognitive outcomes as continuous variables using covariance analyses. ConclusionThis study supports the existence of an inverse cross-time association between midlife vascular risk profiles and subsequent poor cognitive performance, especially in the verbal memory domain. Beyond their importance as regards vascular risk, such risk scores may help primary prevention efforts in identifying and targeting middle-aged individuals at high risk of cognitive aging.

P16.28 Framingham coronary heart disease and cardiovascular risk assessments of hiv/aids malaysian population on haart: the importance of risks evaluations and predictions

Background Coronary heart disease (CHD) and cardiovascular diseases (CVDs) events have increasing trends mainly due to the multiple and complex mechanisms of chronic inflammation and anti-retroviral drugs adverse effects during HIV course. Due to the lack of information this study aimed to analyse the CHD and CVDs risk profiles, estimate the probability of events and evaluate the accuracy of the Framingham CHD equations comprehensively in HIV-infected Malaysian subjects on highly active antiretroviral therapy (HAART). Methods This is a cross-sectional study with a purposive sampling of 2046 HIV patients on HAART in an outpatient infectious disease clinic in Selangor Malaysia. Using digital medical records. all variables for Framingham equations including demographics, gender, fasting plasma glucose and lipid profiles, blood pressure, smoking and diabetes status, hypertension treatment, immunity indices and antiretroviral therapy were collected. 10-years CHD risks were predicted using Framingham Risk Score (FRS1998 and FRS 2002) models while CVDs risk by specific FRS (2008). Data analyses included descriptive statistics and binary logistic regression. Results CHD risks were estimated in 1920 (FRS 1998) and 2046 (FRS 2002) of HIV subjects while CVDs risk were evaluated in 1927 subjects. Median ages and percentage of male were 44 years and 81.4% (FRS 1998, 2002 and FRS 2008). Approximatly 90% were receiving NNRTI+ NRTI and just 13% and 10% were taking tenofovir and a protease inhibitor. Beside 11% were smokers while 14% as diabetic. Dyslipidemia was seen at least in 45% of population. Equally 8% had CD4 count Conclusions We found a high prevalence of dyslipidemia while the CHD risks measured by the Framingham scales 1998 and 2002 were low. Notably CVDs risk was high thus further investigations as well preventive management should be prioritised in this population.

Coronary Heart Disease Risk Profile among University of Kwa-Zulu Natal Students

Coronary heart disease (CHD) is one of the primary aetiological factors of mortality in many countries. People are no longer as physically active as they were a few decades ago, because of their sedentary lifestyles. This study was conducted to determine the coronary heart disease risk profile of students studying at the Westville campus of the University of Kwa-Zulu Natal (UKZN). Two hundred and twenty-three students who volunteered participated in the study. Participants underwent a health screening and risk stratification assessment which included an interview (to determine exercise history, and prevalence of hypokinetic diseases), kinanthropometric measures (body mass, stature and skinfold), resting 2 heart rate and blood pressure measures and a bicycle ergometer PWC test (indirectly 170 estimate VO max). Descriptive statistics which included mode, mean, frequency, percentages and inferential statistics comprising chi-square (p# 0.05) were employed in the statistical analysis. All participants reported no history of hypokinetic disease and perceived they were not at risk of CHD (p<0.001). The exercise history of males revealed that 86.66% participated in exercise, cricket, soccer, rugby and hockey, while 13.34% were sedentary (X2 p-value; 1.58E-17). Females (88.64%) were more physically active participating in netball, hockey, athletics and exercise, whilst 11.36% were sedentary (X2p-value; 4.2E-13). Active female participants exercised and played sport for 2.38 sessions per week for an average duration of 34.28 minutes per session. The active male participants exercised and played sport for 0.65 sessions per week for an average of 30 minutes per session. Descriptive statistical analyses identified the female participants’ mean BMI (24.34 kg/m²), percent body 2 fat (20.72%), resting heart rate (78.19 bpm), mean arterial pressure (87.85 mmHg) and V0 max (38.93 ml/kg/min) as being within their age and gender norms. Similarly male participants’ mean BMI (23.05 kg/m²), 2 percent body fat (12.29%), resting heart rates (73.14 bpm), MAP (87.75 mmHg) and VO max (39.03 ml/kg/min) complied with their age and gender norms. The study concluded that the participants are not at risk of CHD. KEYWORDS: coronary heart disease, health

Trends in coronary heart disease mortality and statin utilization in two European areas with different population risk levels: Stockholm and Sicily

Background and Aim: The reduction in coronary heart disease (CHD) mortality in Europe has been associated with a&lt;br /&gt;reduction in coronary risk factors, including dyslipidaemia. Statins reduce blood cholesterol levels and the risk of coronary&lt;br /&gt;events. Their utilization has substantially increased over the years. Although statins should be prescribed according to clinical&lt;br /&gt;guidelines, doctors’ decisions about treatment are usually made subjectively and are influenced by the population risk level.&lt;br /&gt;The aim of this study was to investigate the relation between the time trend of population risk level and statin utilization in two&lt;br /&gt;areas with different levels of coronary risk in the population.&lt;br /&gt;Methods: CHD mortality, as a proxy of population coronary risk level, and statin utilization trends in the period 2001-2011,&lt;br /&gt;were compared between a relatively high-risk CHD area, Stockholm county, and a low-risk area, Sicily.&lt;br /&gt;Results: There was a reduction in CHD mortality and an increase in statin utilization in both areas. The mean annual reduction&lt;br /&gt;in CHD mortality rate/100,000 was greater in Stockholm than in Sicily (-4.6, 95% CI -5.3 -4.0, and -1.9 95% CI -2.6 – 1.2,&lt;br /&gt;respectively). The mean annual increase in statin DDD/TID utilization was larger in Sicily than in Stockholm (5.1, 95% CI 4.8 –&lt;br /&gt;5.3, and 3.7, 95% CI 3.2 – 4.1, respectively). In Stockholm the increase in statin use was mainly due to increased utilization of&lt;br /&gt;simvastatin, whereas it included a greater variety of statins in Sicily.&lt;br /&gt;Conclusion: The relations between time trends of CHD mortality and statin utilization in Stockholm and in Sicily were&lt;br /&gt;different. A larger increase in statins was observed in the low-risk area, associated with a slower reduction in CHD mortality,&lt;br /&gt;whereas a smaller increase in statins was observed in the high-risk area, associated with a greater reduction in CHD mortality.&lt;br /&gt;Other factors apart from the actual risk of the patients may explain these observations, such as differences in socioeconomic&lt;br /&gt;factors, adherence to treatment, policies of drug cost-containment, and population CHD risk profiles.

Modulation of coronary heart disease risk by insulin resistance in subjects with normal glucose tolerance or prediabetes.

This study was based on the hypothesis that: (1) coronary heart disease (CHD) risk is accentuated in the insulin-resistant subset of persons with normal glucose tolerance (NGT) or prediabetes (PreDM); (2) the prevalence of insulin resistance, and associated abnormalities, is greater in subjects with PreDM; and (3) insulin resistance is the major contributor to increased CHD risk in these individuals. A 75 g oral glucose challenge was used to classify volunteers as having NGT or PreDM. Steady-state plasma glucose (SSPG) concentrations during the insulin suppression test subdivided both groups into insulin sensitive (IS = SSPG < 8.4 mmol/L) or resistant (IR = SSPG ≥ 8.4 mmol/L). Measurements were made of demographic characteristics, blood pressure, and lipid and lipoprotein concentrations, and comparisons made between the subgroups. Subjects with PreDM (n = 127) were somewhat older, more likely to be non-Hispanic men, with increased adiposity than those with NGT (n = 315). In addition, they had higher FPG concentrations, were insulin resistant (SSPG concentration; 11.4 vs. 7.2 mmol/L), with higher blood pressures, and a significantly more adverse CHD risk lipid profile (p < 0.001). Twice as many subjects with PreDM were IR (72 vs. 35 %), and the CHD risk profile was significantly worse in the IR subgroups in those with either NGT or PreDM. Coronary heart disease risk profile is significantly more adverse in subjects with PreDM as compared to individuals with NGT. However, glucose tolerance status is not the only determinant of CHD risk in nondiabetic individuals, and differences in degree of insulin resistance significantly modulate CHD risk in subjects with NGT or PreDM.

A Preliminary Study of the Relationship between Promoter Methylation of the ABCG1, GALNT2 and HMGCR Genes and Coronary Heart Disease

AimsTo investigate the association of ABCG1, GALNT2 and HMGCR genes promoter DNA methylation with coronary heart disease (CHD) and explore the interaction between their methylation status and the CHD patients' clinical characteristics in Han Chinese population.Methods and resultsMethylation-specific polymerase chain reaction (MSP) technology was used to examine the role of the aberrant gene promoter methylation in CHD in Han Chinese population. A total of 85 CHD patients and 54 participants without CHD confirmed by angiography were recruited. 82.8% of the participants with ABCG1 gene promoter hypermethylation have CHD, while only 17.4% of the participants without hypermethylation have it. The average age of the participants with GALNT2 gene promoter hypermethylation is 62.10±8.21, while that of the participants without hypermethylation is 57.28±9.87; in the former group, 75.4% of the participants have CHD, compared to only 50% in the latter group. As for the HMGCR gene, the average age of the participants with promoter hypermethylation is 63.24±8.10 and that of the participants without hypermethylation is 57.79±9.55; its promoter hypermethylation is likely to be related to smoking. Our results indicated a significant statistical association of promoter methylation of the ABCG1 gene with increased risk of CHD (OR = 19.966; 95% CI, 7.319–54.468; P *<0.001; P *: adjusted for age, gender, smoking, lipid level, hypertension, and diabetes). Similar results were obtained for that of the GALNT2 gene (OR = 2.978; 95% CI, 1.335–6.646; P * = 0.008), but not of HMGCR gene (OR = 1.388; 95% CI, 0.572–3.371; P * = 0.469).ConclusionsThe present work provides evidence to support the association of promoter DNA methylation status with the risk profile of CHD. Our data indicates that promoter DNA hypermethylation of the ABCG1 and GALNT2 genes, but not the HMGCR gene, is associated with an increased risk of CHD. CHD, smoking and aging are likely to be the important factors influencing DNA hypermethylation.