CVD Risks Research Articles

EFFECTS OF EXERCISE TRAINING ON THE AUTONOMIC NERVOUS SYSTEM IN HYPERTENSION: A COMPREHENSIVE REVIEW

Background: Cardiovascular diseases, significant health burdens globally, and conditions, including prevalent heart failure and hypertension, lead to increased hospitalizations, especially in the elderly, and account for substantial medical expenditures in developed nations. The emergence of hypertension as major global health challenges has intensified the focus on understanding and managing these conditions. Central to this endeavour is the exploration of the autonomic nervous systems role, particularly sympathetic nerve activity (SNA), in the pathophysiology of these diseases.Exercise training, a key non-pharmacological approach, has shown promise in mitigating these effects and reducing CVD risks, though the exact mechanisms remain under investigation. Objectives: To evaluate the effects of exercise training on sympathetic nervous activity on hypertensive individuals Method:A comprehensive review of observational, experimental, randomized control trial, cross-sectional studies were performed. SCOPUS, Google scholar, EBSCO and PubMed were searched using the terms exercise training, autonomic nervous activity, hypertension. Result: A total of 426 studies were identified of which 13 studies were published between 2010-2023 and were included in the study. Out of 426 studies, 12 studies which were included in our study showed positive effects of exercise training on the autonomic nervous system on hypertensive individuals Conclusion: This study concluded that there is significant relation between the exercise training and autonomic nervous system in hypertension.

Estimated impact of inclisiran treatment on hyperlipidemia prevalence and cardiovascular disease events in NHANES dataset

Abstract Background Inclisiran, administered subcutaneously every 6 months, will result in the reduction of LDL-cholesterol levels of approximately 50%. We estimated the eligibility of the US population for Inclisiran treatment and its impact on blood lipids and CVD events. Methods We applied ORION trial eligibility criteria to US adults aged ≥ 18 years in the US NHANES 1999-2018 to estimate the US eligible population. Blood lipid alterations in ORION 10 were applied to estimate the impact on LDL-C levels and hyperlipidemia prevalence in the ASCVD population sample. We also used the Framingham CVD risk scores to estimate 10-year CVD risks in the ASCVD high-risk population sample based on ORION 11. The difference in estimated risks with and without Inclisiran administration, multiplied by the eligible population from NHANES data, represented the potentially preventable CVD events. Results We identified 651 ASCVD persons (projected to 5.55 million) who fit ORION 10 trial eligibility criteria and 359 ASCVD high-risk persons (projected to 2.53 million) who fit ORION 11 trial eligibility criteria for our analysis. We then analyzed the changes in these populations after Inclisiran treatment. Firstly, we estimated that approximately 3.9 million (72.8%) individuals would experience ≥50% LDL-C reductions. Secondly, we estimated that among the ASCVD patients, 5.07 million (91.3%) with elevated LDL-C, 0.25 million (22.8%) with reduced HDL-C, 1.24 million (95.2%) with elevated TC, and 0.65 million (32.4%) with elevated TG would potentially achieve a more reasonable blood lipid level. Finally, among those without CVD, the estimated 10-year CVD risks were 19% before and 13.8% after Inclisiran treatment, reflecting a 5.2% absolute (and 27.4% relative) reduction in risk translating to potentially 130,000 preventable CVD events over 10 years. Conclusion Inclisiran treatment in eligible US adults may substantially reduce hyperlipidemia prevalence and CVD events.core graphics

MultiNet 2.0: A lightweight attention-based deep learning network for stenosis measurement in carotid ultrasound scans and cardiovascular risk assessment

BackgroundCardiovascular diseases (CVD) cause 19 million fatalities each year and cost nations billions of dollars. Surrogate biomarkers are established methods for CVD risk stratification; however, manual inspection is costly, cumbersome, and error-prone. The contemporary artificial intelligence (AI) tools for segmentation and risk prediction, including older deep learning (DL) networks employ simple merge connections which may result in semantic loss of information and hence low in accuracy. MethodologyWe hypothesize that DL networks enhanced with attention mechanisms can do better segmentation than older DL models. The attention mechanism can concentrate on relevant features aiding the model in better understanding and interpreting images. This study proposes MultiNet 2.0 (AtheroPoint, Roseville, CA, USA), two attention networks have been used to segment the lumen from common carotid artery (CCA) ultrasound images and predict CVD risks. ResultsThe database consisted of 407 ultrasound CCA images of both the left and right sides taken from 204 patients. Two experts were hired to delineate borders on the 407 images, generating two ground truths (GT1 and GT2). The results were far better than contemporary models. The lumen dimension (LD) error for GT1 and GT2 were 0.13±0.08 and 0.16±0.07 mm, respectively, the best in market. The AUC for low, moderate and high-risk patients’ detection from stenosis data for GT1 were 0.88, 0.98, and 1.00 respectively. Similarly, for GT2, the AUC values for low, moderate, and high-risk patient detection were 0.93, 0.97, and 1.00, respectively.The system can be fully adopted for clinical practice in AtheroEdge™ model by AtheroPoint, Roseville, CA, USA.

Role of SGLT2 inhibitors in improving cardiac functions (on Echocardiography) in patients having Diabetes Mellitus and ischemic heart disease

BACKGROUND & OBJECTIVE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i or SGLT2 inhibitors) have a distinctive mechanism of action unrelated to insulin secretion or action. By causing glucosuria, they reduce plasma glucose by inhibiting SGLT2 in the proximal tubules of the kidneys. This mechanism of action corrects several metabolic abnormalities, which are, in fact, CVD risks in addition to normoglycemia. This study was conducted to assess the average change in ejection fraction resulting from the use of SGLT2 inhibitors in enhancing cardiac function in patients with Diabetes Mellitus and ischemic heart disease. METHODOLOGY: This is a descriptive case series conducted from 10th December 2022 to 9th May 2023 in the Department of Medicine, Faisalabad Medical University; 435 type II diabetes mellitus patients were selected, according to inclusion and exclusion criteria. All received a daily dose of 20 mg of SGLT2 for three months. Echocardiography was done before and after the treatment period left ventricular ejection fraction (EF) was evaluated, and improvement in cardiac function was noted. RESULTS: In this study, the mean age of participants was 46.54±8.52 years. 314 (72.18%), or the majority, were between 30 and 50. The male-to-female ratio was 1.1:1, with 228 (52.41%) men and 207 (47.59%) women. The mean ejection fraction at baseline was 53.45 ± 4.12. The mean change in ejection fraction of SGLT2 inhibitors in improving cardiac functions among patients having Diabetes Mellitus and ischemic heart disease was 50.79 ± 3.76.( p-value ≤0.001). CONCLUSION: SGLT2 inhibitors effectively improve cardiac functions among patients with Diabetes Mellitus type II and ischemic heart insult

Trends in cardiovascular disease among Inuit in Greenland from 1994 to 2021

Background and aimsCardiovascular disease (CVD) poses significant health challenges globally. While substantial data exists for most populations, the Arctic Inuit's CVD incidence rates remain understudied. This research aimed to change this by estimating CVD incidence and mortality rates in Greenland from 1994 to 2021. MethodsUsing nationwide registers, a retrospective observational study was conducted, focusing on individuals born in Greenland to Greenlandic-born parents. Data were sourced from the Greenlandic Hospital Discharge Register and the nationwide electronic medical record. ResultsA total of 65,824 individuals were included. the age- and sex-specific incidence rates (IR) of ischemic heart disease, stroke, and heart failure (HF) declined from 1994 to 2021, with the most substantial decline observed for HF among women. Conversely, the IR of atrial fibrillation/flutter increased in both men and women, while the IR of myocardial infarction rose among men. The IR for stroke was particularly elevated compared to other CVD subgroups. Mortality rates for those diagnosed with CVD were 2.4 times higher than those without. Men exhibited a 40 % elevated mortality risk relative to women. ConclusionThe study provides pivotal insights into CVD trends within the Arctic Inuit population, highlighting both positive developments and areas of concern. Given the increasing elderly demographic in Greenland, proactive health strategies are crucial. Emphasizing primary prevention and addressing specific CVD risks, particularly the elevated stroke IR, is imperative for future public health efforts.

Re‐examination of statistical relationships between dietary fats and other risk factors, and cardiovascular disease, based on two crucial datasets

AbstractCardiovascular disease (CVD) is the major cause of death in many regions around the world, and several of its risk factors might be linked to diets. To improve public health and the understanding of this topic, we look at the recent Minnesota Coronary Experiment (MCE) analysis that used t‐test and Cox model to evaluate CVD risks. However, these parametric methods might suffer from three problems: small sample size, right‐censored bias, and lack of long‐term evidence. To overcome the first of these challenges, we utilize a nonparametric permutation test to examine the relationship between dietary fats and serum total cholesterol. To address the second problem, we use a resampling‐based rank test to examine whether the serum total cholesterol level affects CVD deaths. For the third issue, we use some extra‐Framingham Heart Study (FHS) data with an A/B test to look for meta‐relationship between diets, risk factors, and CVD risks. We show that, firstly, the link between low saturated fat diets and reduction in serum total cholesterol is strong. Secondly, reducing serum total cholesterol does not robustly have an impact on CVD hazards in the diet group. Lastly, the A/B test result suggests a more complicated relationship regarding abnormal diastolic blood pressure ranges caused by diets and how these might affect the associative link between the cholesterol level and heart disease risks. This study not only helps us to deeply analyze the MCE data but also, in combination with the long‐term FHS data, reveals possible complex relationships behind diets, risk factors, and heart disease.

Adiponectin/resistin evaluation is a gold biomarker for monitoring CVD in patients with metabolic syndrome

Abstract Introduction/Objective Introduction: Various studies have tried correlating specific inflammatory markers with metabolic syndrome. Serum adiponectin levels can serve as a biomarker that predicts metabolic syndrome development. Resistin is another adipose-tissue-derived hormone capable of promoting insulin resistance because it increases the reserve of triglycerides in the muscle and the liver rather than the adipose tissue. Methods/Case Report Objectives: To investigate the role of the adiponectin/resistin ratio in monitoring CVD in Jordanian adults with metabolic syndrome. Methods Eighty subjects were randomly selected from individuals who attended two clinical laboratories for routine checks during the period between January 2021 and March 2021. Forty-two participants had metabolic syndrome, while the other 38 represented the healthy group. Resistin and adiponectin were evaluated using the ELISA method, while the adiponectin/resistin ratio was calculated. Lipid profile, glucose and body mass index (BMI) were measured for all metabolic syndrome patients and healthy control ones. Results (if a Case Study enter NA) Results: Plasma resistin levels were significantly higher in metabolic syndrome patients than in healthy controls (p = 0.04), while no significance was found regarding adiponectin (p = 0.07). In contrast, the adiponectin/resistin ratio was highly significant (p < 0.001). Resistin had shown a negative correlation with HDL (r= -0.33), whereas adiponectin was inversely correlated with LDL (r= -0.33) and LDL/HDL ratio (r= -0.34). Adiponectin/resistin ratio positively correlated with HDL (r= 0.45). The multiple linear regression analysis results revealed the predictive potential of adiponectin and resistin when used in different models for CVD risks using HDL as a risk factor. However, the results revealed that only the third model, which included the adiponectin/resistin ratio, was expected to have a higher CVD risk after controlling for the other predictors in the same model. Conclusion The studied metabolic syndrome markers might have an essential role in detecting cardiovascular events. It can be concluded that resistin can be used to evaluate the CVD risks. Furthermore, we found that the adiponectin/resistin ratio is the best marker in predicting CVD events in metabolic syndrome patients compared to other markers, including adiponectin and resistin alone.

Sleep duration and Framingham´s cardiovascular risk score: results from the Hoveyzeh Cohort Study (HCS)

BackgroundCardiovascular diseases (CVDs) are the leading causes of global deaths. So, it is necessary to know the possible risk factors for each region. We aimed to assess the relationship between the risk of CVDs and sleep duration in the Iranian Arab population.MethodsIn this cross-sectional study, data from 8362 participants aged between 35 and 70 from the Hoveyzeh Cohort Study enrollment phase between 2016 and 2018 was analyzed. This study evaluated the association between ten-year CVD risk using the Framingham risk score and sleep duration. Self-reported sleep duration was categorized as short duration (equal to or less than 5 h), standard duration (6–8 h), or prolonged duration (equal to or greater than 9 h). Multivariable logistic regression to adjust for conventional CVD risks was used.ResultsAmong the assessed participants, 4892 (58.50%) were female, and the mean age was 47.93 (9.01). The average sleep duration was 7.59 (1.56) hours. The low, intermediate-to-high, and high CVD risk individuals were 6461 (77.27%), 1185 (14.17%), and 716 (8.56%), respectively. There was a significant relationship between prolonged sleep duration and lower odds of intermediate-to-high CVD risk in males (OR 0.66, 95% CI: 0.49–0.87, P-value: 0.004).ConclusionThe results of our study showed that longer sleep duration has a protective association with the intermediate to high risk of cardiovascular diseases in males. However, long and short sleep durations have no significant relationship with females’ risk of cardiovascular disease.

Association of rs2073618 polymorphism and osteoprotegerin levels with hypertension and cardiovascular risks in patients with type 2 diabetes mellitus

There are reports of link of osteoprotegerin (OPG) gene polymorphism to type-2 diabetes (T2D) and hypertension (HTN). The objective of the study was to assess the allele frequency of OPG (rs2073618) gene polymorphism and its association with heart rate variability (HRV) and blood pressure variability profile as CVD risks in diabetes mellitus patients with hypertension undergoing treatment. T2D patients on treatment without hypertension (n = 172), with hypertension (n = 177) and 191 healthy volunteers were recruited for the study. Their blood pressure variability including baroreflex sensitivity (BRS), heart rate variability (HRV), OPG, insulin, lipid profile, receptor-activator for NFkB (RANK), receptor-activator for NFkB-Ligand (RANKL), and tumor necrosis factor-α (TNF-α) were estimated. Allele frequency of OPG (rs2073618) gene polymorphism was assessed from the DNA samples. BRS and HRV indices were decreased, and RANKL/OPG and TNF-α were increased in T2D and T2D + HTN groups, respectively compared to healthy control group. The reduction in BRS was contributed by increased inflammation and reduced SDNN of HRV in GG genotype in T2D + HTN. In GG + GC subgroup, it was additionally contributed by rise in RANKL/OPG level (β − 0.219; p 0.008). Presence of mutant GG genotype contributed to the risk of hypertension among T2D patients (OR 3.004) as well as in general population (OR 2.79). It was concluded that CV risks are more in T2D patients with HTN expressing OPG rs2073618 gene polymorphism.

THU075 Sex And Age Specificity Of Correlations Among IGF-1, GH, And Duodenal Microbial Diversity Predicting TMA Biosynthesis

Abstract Disclosure: N. Tal: None. G. Leite: None. G. Barlow: None. W. Morales: None. R. de Souza Santos: None. M. Pimentel: None. R. Mathur: None. Varied gut microbial profiles and functional potentials may increase or decrease cardiovascular (CVD) disease risk. Trimethylamine (TMA), a known bacterial metabolite associated with red meat ingestion, is linked to increased CVD risk and morbidity through its liver-transformed form trimethylamine N-oxide (TMAO). As the somatotroph axis is also linked both to the microbiome and CVD morbidity, we explored the relationships between the duodenal microbiome, microbial pathways, IGF-1 and GH levels. Methods: Female (F) and male (M) subjects undergoing upper endoscopy without colon prep were enrolled and completed a medical history including CV conditions and risk factors such as exercise and diet. Whole blood was collected and duodenal aspirates obtained using a double lumen sterile catheter. Microbial DNA was extracted and 16S sequenced. Analyses were performed with CLC Microbial Module. Predicted pathways were identified using MetaCyc Database. Fasting circulating GH, IGF-1 (Luminex FLEXMAP) and cholesterol fractions (Cobas 400) were measured. Results: 177 subjects were grouped by age (sex and BMI, P=NS): 18-35yrs (N=21, F=11), 36-50yrs (N=29, F=15), 51-65yrs (N=69, F=38) and 66-80yrs (N=58, F=28). IGF-1 levels gradually decreased in older subjects (P<0.0001). In older M (66-80yrs), GH correlated positively with IGF-1 (R=0.371, P=0.044) and negatively with duodenal microbial diversity (R=-0.517, P=0.003). M and F had similar CVD risks (hypertension, smoking, exercise habits, obesity, LDL levels and weekly red meat consumption [P=NS for all]). In M only: 1) GH levels correlated with overall number of CV conditions (R=0.339, P=0.001), 2) Red meat consumption correlated with GH (R=0.353, P=0.002) and predicted microbial TMA biosynthesis from L-carnitine (R=0.272, P=0.009), and 3) Higher IGF-1 correlated with predicted microbial TMA production from L-carnitine (R=0.208, P=0.05) and predicted microbial conversion of TMA to TMAO (R=0.257, P=0.018). Duodenal relative abundance (RA) of Prevotellaceae (which positively impacts duodenal microbial diversity) inversely correlated with both GH (R=-0.174, P=0.019) and predicted TMA production (R=-0.174, P=0.019). Positive associations among Prevotellaceae and duodenal diversity (R=0.570, P<0.0001) and inverse associations with TMA production (R=-0.354, P=0.029) were stronger in older M (66-80yrs). In M, Prevotellaceae RA decreased gradually with age (P=0.023). Conclusion: IGF-1 and GH levels exhibit differential relationships with the duodenal microbiome and cardiovascular risk. In males, IGF-1 levels strongly associate with duodenal microbial pathways linked to TMA production and conversion to TMAO. Red meat consumption is linked to GH levels and to predicted TMA biosynthesis pathways. The microbial family Prevotellaceae appears to mitigate predicted TMA production and its relative abundance is lower in older men. Presentation: Thursday, June 15, 2023

Increased incidence risks of cardiovascular disease among cancer patients: Evidence from a population-based cohort study in China

BackgroundCardiovascular disease (CVD) is becoming a major concern among cancer patients, leading to the development of a new field named cardio-oncology. However, previous studies were mainly based on the western population and focused on CVD mortality. Evidence from the Chinese population is limited. Furthermore, few studies investigated the incidence risks of CVD among cancer patients. Methods85,787 eligible cancer patients were included from Hangzhou city, China. Age-standardized standard incidence ratio (SIR) was used to reflect the incidence risks of CVD among cancer patients as compared with the standard population, which was defined as all residents in Hangzhou city during the same period. ResultsAfter three years of follow-up, cancer patients showed elevated incidence risks of CVD (SIR = 1.41, 95%CI: 1.35–1.47) as compared with the standard population. The elevated risks of CVD were highest in the first year after cancer diagnosis (SIR = 1.68, 95%CI: 1.58–1.78), then followed by the second (SIR = 1.21, 95%CI: 1.11–1.31) and the third (SIR = 1.18, 95%CI: 1.07–1.29) year. These results were consistent in males and females. Furthermore, different risks of CVD were observed among different cancer sites. Patients with pancreatic cancer showed the highest risks of CVD, then followed by liver cancer, lung cancer, kidney cancer, gastric cancer, bladder cancer, prostate cancer, and colorectal cancer. ConclusionsCancer patients have increased incidence risks of CVD, especially in the first year after cancer diagnosis. The increased risks of CVD vary by different cancer sites. Our findings highlight the importance of paying close attention to the CVD risks among cancer patients.

Trends and Gaps in Statin Use for Cardiovascular Disease Prevention in Type 2 Diabetes: A Real-World Study in Shanghai, China

BackgroundCardiovascular disease (CVD) is the major cause of death among persons with diabetes. As the preventative use of statin has been proved to reduce CVD risks, understanding the current status and the trend in statin use is crucial to improve clinical treatment strategies. ObjectiveOur study aimed to answer the question of what were the status and trend of statin use in Shanghai, China. MethodsOur study estimated statin use and trends from 2015 to 2021 among 702 727 patients with type 2 diabetes mellitus (T2DM) based on electronic health records from the Shanghai Hospital Link Database. Patients were grouped according to the presence of CVDs, tested separately for statin primary and secondary prevention use, and stratified by age and sex. ResultsIn the study population, 221 127 patients (31.5%) received statin therapy, and among patients with CVD, 157 622 patients (51.62%) received statin therapy for secondary prevention, but only 15% of patients received statins for primary prevention. The trend in the use of statins was still on the rise from 28.3% in 2015. Statin use increased with age (18-39 years, 14.0%; 40-59 years, 26.8%; 60-74 years, 33.35%; and 75 and over, 36.1%), and women (29.7%, n = 93 977) were less likely to receive statin therapy compared to men (32.9%, n = 127 150). ConclusionDespite the rise in statin use in T2DM in recent decades, a large proportion of subjects with T2DM did not receive statin therapy.

Trends in predicted 10-year risk for cardiovascular diseases among patients with type 2 diabetes in Thailand, from 2014 to 2018

BackgroundCardiovascular diseases (CVD) are the leading causes of death globally, including Thailand. Approximately one-tenth of Thai adults have type 2 diabetes (T2D), a significantly increasing CVD. Our study aimed to determine the trends of predicted 10-year CVD risk among patients with T2D.MethodsA series of hospital-based cross-sectional studies were conducted in 2014, 2015 and 2018. We included Thai patients with T2D aged 30–74-year-old without a history of CVD. The predicted 10-year risk for CVD was calculated based on Framingham Heart Study equations both with simple office-based nonlaboratory and laboratory-based. Age- and sex-adjusted means and proportions of predicted 10-year risk for CVD were calculated.ResultsA total of 84,602 patients with T2D were included in the present study. The average SBP among study participants was 129.3 ± 15.7 mmHg in 2014 and rose to 132.6 ± 14.9 mmHg in 2018. Likewise, the average body mass index was 25.7 ± 4.5 kg/m2 in 2014 and elevated to 26.0 ± 4.8 kg/m2 in 2018. The age- and sex-adjusted mean of the predicted 10-year CVD risk (simple office-based) was 26.2% (95% CI: 26.1–26.3%) in 2014 and rose to 27.3% (95% CI: 27.2–27.4%) in 2018 (p-for trend < 0.001). While the age- and sex-adjusted mean of the predicted 10-year CVD risk (laboratory-based) ranged from 22.4–22.9% from 2014 to 2018 (p-for trend < 0.001). The age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (simple office-based) was 67.2% (95% CI: 66.5–68.0%) in 2014 and significantly rose to 73.1% (95% CI: 72.4–73.7%) in 2018 (p-for trend < 0.001). Nevertheless, the age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (laboratory-based) ranged from 46.0–47.4% from 2014 to 2018 (p-for trend = 0.405). However, among patients with available laboratory results, a significantly positive correlation was noted between predicted 10-year CVD risk, simple office-based and laboratory-based (r = 0.8765, p-value < 0.001).ConclusionOur study demonstrated significant rising trends in the predicated 10-year CVD risk among Thai patients with T2D. In addition, the results empowered further improved modifiable CVD risks, especially regarding high BMI and high blood pressure.

Socioeconomic and Behavioral Determinants of Cardiovascular Risk in Russia: A Structural Equation Modeling Approach.

Despite much attention within the literature, the multiple risk factors associated with CVD mortality in Russia are still not fully understood. Drawing on the Health Belief Model as a theoretical framework, we aim to elicit socioeconomic and behavioral determinants of cardiovascular risks in Russian men and women. Using the Know Your Heart project data, we utilize regression analysis and then structural equation modeling (latent class analysis and mediation analysis) to study the determinants of CVD risks. OLS and ordered logit regressions show that the key factors defining cardiovascular health behaviors in Russia are health-related actions to reduce the perceived threat of diseases (physical activity and GP visits), perceived barriers to behavioral change (financial constraints), and cues to action (awareness of the federal health check-up program). The latent class analysis further identifies three distinct groups of the population with different CVD risk levels. Over one-third of respondents belong to the "high CVD risk" class characterized by the highest share of smokers and alcohol abusers who evade contact with primary care and face financial constraints. In the mediation analysis, we find that employment mediates the relationship between physical activity and CVD risks: physically active individuals have a greater chance of employment, and employment further mitigates CVD risks. We also find an indication of the selection of the healthy into employment in the causal relationship between GP visits, having a job, and CVD risks. A corresponding set of policy actions stem from these findings. These include reinforcing the change of perceptions of CVD risks and lowering barriers to health care; raising awareness of the free preventive check-up program in the "high CVD risk" group; making sports and exercise accessible to the elderly; and using off-putting labels on alcohol products as behavioral nudges among "physically active but drinking" males.

Electrocardiographic Changes in Young Healthy Male Smokers

Background: Smoking increases the risk of CVD, however, the magnitude of this increase in risk varies substantively according to a range of factors. Smoking-related CVD risks are highest in current and recent smokers, compared to never smokers and those who have quit in the more distant past. Risk also increases with increasing duration of use and with greater intensity of smoking, as measured by the number of cigarettes smoked per day. Methods: In the present study, a total of 60 male smokers having a history of smoking of more than 2 years and smoking at least 3 cigarettes per day were included in the study, provided they met the inclusion and exclusion criteria. 60 healthy male patients were included as controls/non-smokers. Demographic details were noted. Past, present and other relevant histories were recorded. Physical examination was done. Standard 12 lead ECG was done in the resting state after 2 hours of abstinence from strenuous physical activity, smoking and/or any caffeinated beverages. Results: In the present study, it was observed that the mean age of the non-smokers was lower (27.85 ± 5.11 years) than that of smokers (30.22 ± 5.26 years); P value: 0.014. Only males were included in the present study. The BMI and heart rate were similar in the smokers and non-smokers; P value: more than 0.05. The majority of the cases had normal axis on ECG in both the groups (86.66% in non-smokers and 70% in smokers). Left axis deviation was more common than the right axis deviation in both the groups. The difference between the two groups was statistically insignificant; P value: 0.063. The width and height of the P wave were similar in both the groups; P value: more than 0.05. The R wave was significantly bigger in the smokers (12.53 ± 4.63 mm) than in the non- smokers (10.05 ± 2.93 mm); P value: 0.001. The duration of PR interval was significantly more in the smokers (140.10 ± 18.37 ms) as compared to non-smokers (129.45 ± 19.90 ms); P value: 0.003. T wave inversion was present in 10% cases of smokers while no case in the non-smoker group had T wave inversion; P value: 0.027. The ST segment was normal in most of the cases (98.33% in the non-smokers and 96.66% in the smokers’ groups); P value: more than 0.05. All the cases in both the groups had normal sinus rhythm with normal PR interval, no tall T wave, no wide QRS interval or shortened QT interval. Conclusion: The study concluded that the smokers have a mean age of 30.22 ± 5.26 years. The heart rate is similar to non-smokers. In general, normal axis on ECG is more common. Left axis deviation is more prevalent than right axis deviation. Smokers have bigger R waves, increased PR duration and inverted T waves. This may be because smoking generally causes a transient increase in heart rate and ECG changes, especially those pertaining to ST-T segment.

Pre-eclampsia and cardiovascular risk: a long-term nationwide cohort study on over 120 000 Finnish women

ObjectivesTo investigate the impact of pre-eclampsia on the future cardiovascular risk in Finnish womenDesignA registry-based nationwide controlled cohort study.SettingWomen hospitalised for pre-eclampsia in 1969–1993 and control women with a history...

Social determinants of incidence, outcomes, and interventions of cardiovascular disease risk factors in American Indians and Alaska Natives

AbstractCardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives (AIANs). Despite copious research on CVD incidence and outcome discrepancies, a social determinants of health (SDOH) focused framework on CVD risk factors and health outcomes in AIAN populations has not been undertaken. This paper presents the following: (1) a review of the literature on SDOH and CVD in AIAN populations, (2) a summary on intersectionality as it relates to SDOH and CVD, (3) a framework for conceptualizing CVD risks, interventions, structural determinants, and health equity, (4) a summary of potential interventions to address CVD in AIANs, and (5) a discussion about future work. Common SDOH themes across the CVD risk factors in AIANs are income‐related obstacles, healthcare access, structural racism, discrimination, and failed colonial policies. Colonization of AIAN populations has resulted in social, political, and economic disadvantages, manifesting as systemic socioeconomic disadvantage and unequal access through elevated poverty rates, lower educational attainment, mental health challenges, and decreased healthcare access. These extensive social factors have a multifactorial effect across several CVD risk factors; all ultimately result in elevated CVD morbidity and mortality. Addressing SDOH and diminishing disparities is essential to facilitating improved CVD outcomes for AIANs.

A Comparison of Actual Cardiovascular Disease Risks to the Perceptions of Middle-aged Men: A Cross-Sectional Study

Objective: To determine the actual cardiovascular diseases risk and to compare it with the perceived risk in 40-65 years old men.&#x0D; &#x0D; Methods: We conducted a cross-sectional study in a population determined to be 21.039 men and sample consisted of 400 men. The actual cardiovascular diseases risks of these respondents were calculated using HeartScore, classified as low, moderate, high, or very high. The respondents’ perception of their cardiovascular disease’s risks was categorized as wrong optimists/pessimists and realists. We used multivariate logistic regression models to determine the relationships between perceived cardiovascular diseases risk and independent variables (age, diabetes, hypertension, etc.). Required ethics committee and institutional permissions were obtained for the duly conduct of the study.&#x0D; &#x0D; Results: It was determined in our study that while 8.3% (n=33) of the men had a high-risk level for cardiovascular disease, 52.5% (n=210) had a very high level. Forty-eight percent of the participants perceive their CVD risks to be lower than they are and 23.8% to perceive it higher than they are. Correct estimation rate of CVD risk was 28.2%. The variables affecting the actual cardiovascular diseases risk were diastolic blood pressure, body mass index, and level of physical activity. 13.3% (n=53) of respondents perceived their cardiovascular diseases risks as high and 8% (n=32) as very high. The variables affecting an incorrect perceived cardiovascular diseases risk are being 61-65 years of age (odds ratio=0.34, 95% confidence interval: 0.16-0.73) and a diagnosis of diabetes mellitus (odds ratio=0.45, 95% confidence interval: 0.20-0.99).&#x0D; &#x0D; Conclusion: We observed that more than half of the residents were at a very high level of risk for cardiovascular disease, and approximately one out of every two respondents perceived their risk of cardiovascular disease to be lower than the actual risk. It is recommended risk reducing behaviors be developed and awareness of risk be raised.

Impact of quality of life in developing cardiovascular disease later in life: Graphical chain model of the English Longitudinal Study of Ageing (ELSA)

IntroductionThe aim of this paper is to demonstrate how graphical chain models can be used to model how cardiovascular disease affected quality of life in later life over the course of 17 years of data. MethodsWaves 1-9 of the English Longitudinal Study of Ageing was used to investigate how quality of life changed over each wave using the CASP-19 questionnaire, and whether having experienced a cardiovascular event had an effect on quality of life. ResultsA total of 12,099 participants were included in the study. Participants had a mean age of 64.2 years, the majority of which were over 50 years old. Older people are more likely to have cardiac events. A one-unit rise in CES-D 8-item score was related with a 14% increased risk of CVD at Wave 1. Those with an O-level, A-level, or degree (or equivalent) had lower CVD risks than those with no education. Women had half the CVD risk of men. Living alone reduced the risk of a CVD-event by 15%. Moderate and vigorous exercise lowered cardiac event risk compared to no exercise. Current or ex-smokers have a 30% higher risk of CVD than non-smokers. Cardiovascular event was significantly associated with quality of life at waves 1 and 2 only. DiscussionEvents related to cardiovascular disease only affected quality of life in later life up to 4 years. Factors such as age, depression, perceived position on social ladder, and high levels of physical activity affected quality of life throughout the majority of waves.

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

USPSTF concludes daily aspirin may hurt more than help, especially for older adults