Determinants Of Cardiovascular Disease Research Articles

Positive Epidemiology?

Positive Epidemiology?

Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review

ABSTRACTPurpose: The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples.Methods: A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n = 15; Sociocultural, n = 17; Behavioral/Physical, n = 19).Results: This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol, and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment – including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors.Discussion: Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.

Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution.

STUDY QUESTIONWhat are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)?SUMMARY ANSWERObesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when lifestyle factors were similar to controls.WHAT IS KNOWN ALREADYWomen with PCOS have an increased prevalence of T2DM.STUDY DESIGN, SIZE, DURATIONA longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen with PCOS (n = 27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38–68 years, served as controls (n = 94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline.MAIN RESULTS AND THE ROLE OF CHANCENone of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P < 0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period.LIMITATIONS, REASONS FOR CAUTIONThe small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain.WIDER IMPLICATIONS OF THE FINDINGSObesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time.STUDY FUNDING/COMPETING INTEREST(S)The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.

Prevalence and determinants of cardiovascular disease in a rural area of Kancheepuram district, Tamil Nadu: a cross sectional study

Background: Cardio vascular disease (CVD) is the number 1 cause of death globally and an estimated 17.7 million people died from CVD in 2015, representing 31% of all global deaths. In India CVD accounts for 25% of all deaths. The objectives of the study was to estimate the prevalence of CVD among the study population and to determine the association between CVD and various risk factors.Methods: This is a cross sectional study carried out in the rural field practice area attached to SBMCH. The study group were 400 adults (20-60 years). The data was collected using a structured questionnaire containing socio-demographic particulars, details regarding CVD risk factors and physical measurements. Data was entered in MS Excel and analysed using SPSS 15 software.Results: Prevalence of CVD is 24.3% and of which hypertension (18%), coronary artery disease (6%), stroke (2.2%) and valvular heart disease (1%). The prevalence of risk factors are age &gt;40 (63%), tobacco use (17.8%), alcohol use (22.3%), physical inactivity (52%), unhealthy diet (61.4%), obesity (19.7%), diabetes (13.6%) and positive family history (21.4%). There is a strong statistically significant association between CVD and age (p=0.008, OR-1.968), tobacco use (p&lt;0.0001, OR-10.029), obesity (p&lt;0.0001, OR-13.462) and positive family history (p&lt;0.0001, OR-13.964).Conclusions: In this study prevalence of CVD is high. It is necessary to minimize the burden of growing CVD by controlling the rates of the risky behaviours by lifestyle modification and by increasing awareness regarding CVD.

The role of single-nucleotide polymorphism rs10824026 of the SYNPO2L gene in the development of atrial fibrillation in a study in the East-Siberian population

Background. Atrial fibrillation (AF) is the most common type of heart rhythm disturbance, leading to the development of lifethreatening conditions, such as cardio embolism, heart failure, and even sudden cardiac death. In recent years, the genetic aspects of AF have been actively discussed. The largest number of genetic predictors of AF was identified after a full genome-wide association studies (GWAS). Given that so far no studies of the association of rs10824026 polymorphism of chromosome 10q22 with the development of AF have been conducted in the Russian population, we conducted this clinical study. Aim. Checking the associations of the development of AF with the single-nucleotide polymorphism rs10824026 of the SYNPO2L gene in the East-Siberian population. Materials and methods. The study design was formed in accordance with the National Standard of the Russian Federation Good Clinical Practice, GOST P 52379-2005. The study uses design - “case-control”. The main group of patients - patients with known cardiac arrhythmias by the type of AF (n=106, average age 57.0±9 years, men 49.4%, women 50.6%), the group was formed using the criteria of the World Health Organization and the European Society of cardiologists. The control group (n=105, average age 57.0±9 years, men - 50.0%, women - 50.0%) was selected by age and gender from the DNA bank of international studies MONICA (Multinational MONItoring of trends and determinants in cardiovascular disease) under a joint agreement with the Research Institute of Therapy and preventive medicine - Novosibirsk. DNA was isolated by phenol-chloroform extraction. Among other things, among the research methods, routine laboratory methods were used; instrumental data; and invasive tactics such as CAG. Results. As a result of clinical genetic testing, it was found that the frequency of G/G polymorphism of the SYNPO2L gene in patients with AF shows a statistically significant difference.

Circulating biomarkers for long-term cardiovascular risk stratification in apparently healthy individuals from the MONICA 10 cohort.

The aim of this study was to examine whether high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble urokinase plasminogen activator receptor (suPAR) carried incremental prognostic value in predicting cardiovascular morbidity and mortality beyond traditional risk factors in apparently healthy individuals. This was a prospective population-based cohort study comprising 1951 subjects included in the 10-year follow-up of the MONItoring of trends and determinants in CArdiovascular disease (MONICA) study, between 1993 and 1994. The principal endpoint was death from cardiovascular causes. Secondary endpoints were death from any cause, coronary artery disease, heart failure, and cerebrovascular disease. Predictive capabilities of each of the three biomarkers were tested using Cox proportional-hazards regression, Harrell's concordance index (C-index), and net reclassification improvement (NRI). Study participants were aged 41, 51, 61, or 71 years, and equally distributed between the two sexes. During a median follow-up of 18.5 years (interquartile range: 18.1-19.0), 177 (9.1%) subjects died from a cardiovascular cause. Hs-CRP (adjusted standardized hazard ratio (HR): 1.37, 95% confidence interval (CI): 1.17-1.60), NT-proBNP (HR: 1.90, 95% CI: 1.58-2.29), and suPAR (HR: 1.35, 95% CI: 1.17-1.57) were all significantly associated with cardiovascular deaths after adjustment for age, sex, smoking status, systolic blood pressure, and total cholesterol (p < 0.001 for all). Furthermore, all three biomarkers were significantly associated with significant NRI. However, only NT-proBNP significantly raised the C-index in predicting death from cardiovascular causes when added to the risk factors (C-index 0.860 versus 0.847; p = 0.02). Hs-CRP, suPAR, and particularly NT-proBNP predicted cardiovascular death and may enhance prognostication beyond traditional risk factors in apparently healthy individuals.

Associations of polyphenolic compounds consumption and the risk of arterial hypertension in the population

Aim . To identify associations of polyphenolic compounds consumption in general, as well as their particular classes with the risk of arterial hypertension (AH) in the population of Novosibirsk residents of the 45-69 age group. Material and methods . In 2003-2005, an epidemiological survey of the population of 45-69 years of Novosibirsk was conducted (HAPIEE international project “Determinants of cardiovascular diseases in Eastern Europe: a multicenter cohort study”). 9360 people were examined, including 4266 men and 5094 women. The average age of the surveyed was 576 years A nutrition assessment was performed using Food Frequency Questionnaire (FFQ) questionnaire. The European base Phenol-Explorer 3,6 was used to estimate the content of polyphenolic compounds and their subclasses. In the structure of each product group, food habits of the Siberian population, typically used products were taken into account. AH was diagnosed in case of systolic blood pressure (SBP) levels >140 mm Hg. and/or diastolic blood pressure (DBP) >90 mm Hg, as well as in individuals with normal blood pressure values while taking antihypertensive drugs in the last two weeks prior to this survey. Results . The risk of AH developing in the quartile with the highest total consumption of polyphenolic compounds in men is 33% less than in the quartile with the lowest consumption (odds ratio (OR) 0,67 confidence interval (CI) 0,56-0,79, P=0.004), and in women, respectively, — 37% less ( OR 0,63, CI 0,54-0,74, P<0,001). For certain classes of polyphenolic compounds: the highest level of consumption of flavonoids associates with a reduction of AH risk in men by 33% (OR 0,67 CI 0,57-0,80, P<0,001) and in women — by 39% (OR 0,61, CI 0,57-0,71, P=0,002). For both men and women, the probability of AH developing in the quartile with consumption of phenolic acids is 21% lower (OR 0,79, CI 0,66-0,94, P=0,002) and 16% (OR 0,84, CI 0,72-0,99, P<0,001), respectively. In men, the consumption of other polyphenols is also significant (the risk with maximum use is reduced by 18%, OR 0,84, CI 0,69-0,98, P=0,018). Conclusion . In the population of Novosibirsk (age group 45-69 years), high levels of consumption of polyphenols in general, as well as such subclasses as flavonoids and phenolic acids, are associated with a decrease of AH risk.

Occupational physical activity and all‐cause and cardiovascular disease mortality: Results from two longitudinal studies in Switzerland

Research regarding the effects of occupational physical activity on health remains inconsistent. We analyzed the association of occupational physical activity with all-cause and cardiovascular disease (CVD) mortality. We analyzed two cohorts with baseline assessments from 1977 to 1993 ("National Research Program 1A" (NRP1A) and "MONItoring of trends and determinants in CArdiovascular disease" [MONICA]) and mortality follow-up until 2015 using adjusted Cox regression models. We included 4396 NRP1A participants (137 793 person-years of follow-up, 1541 deaths) and 5780 MONICA participants (135 410 person-years, 1158 deaths). All-cause mortality was higher for men in the high compared with the low occupational physical activity category according to NRP1A (hazard ratio [HR] 1.25, 95% confidence intervals [CI] 1.05-1.50). CVD mortality was higher for men in the moderate compared with the low occupational physical activity category according to MONICA (HR, 1.41; 95% CI, 1.03-1.91). Results for women were not statistically significant. We observed higher total and CVD mortality risks in men with higher occupational physical activity but inconsistent results for women and across cohorts.

Abstract P008: Pulse Pressure Following a Brief Patient Rest Period: Age and Gender Variations

Background: Increased pulse pressure (PP) is an independent determinant of cardiovascular disease. The effect of rest period on office-based systolic blood pressure has been previously reported, but not on PP in particular. Whether such rest period impacts the measured pulse pressure, and the variability of such response with age and gender remains unknown. Methods: Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained blood pressure (BP) re-measurement data due to elevated initial BP of &gt; 130/80 mmHg. BP was measured initially by the nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was &gt; 130/80 mmHg, it was repeated by the physician after resting the patient for 15 minutes. There were 112 (66%) elderly patients ≥ 60 years of age and 58 (34%) younger patients &lt; 60 years of age. Among the elderly patients, there were 51 males (46%) and 61 females (54%). Results: Among all encounters, after a brief rest period, initial pulse pressure (PP) of 67 ± 2 mmHg decreased to 62 ± 1 mmHg (5 mmHg; P &lt; 0.01). PP decreased by 8 mmHg in the elderly (72 ± 2 to 64 ± 2 mmHg; P &lt; 0.01) but did not significantly change in the young (56 ± 3 to 58 ± 3 mmHg; P = NS). PP decrease among the elderly was more pronounced in females (11 mmHg; 76 ± 4 to 65 ± 2 mmHg; P &lt; 0.01) compared with males (4 mmHg; 68 ± 3 to 64 ± 2 mmHg; P = 0.03). Conclusion: Hypertension is a challenging public health problem. The new ACC/AHA High Blood Pressure Guidelines have decreased the range for Stage 1 hypertension to systolic blood pressure of 130-139 mmHg, and diastolic blood pressure of 80-89 mmHg, with normal blood pressure as less than 120/80 mmHg. Blood pressure guidelines recommend that prior to BP measurement, persons should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level; which resulted in significant decrease in pulse pressure in our patients. We show that while a decrease in pulse pressure was confined to the elderly, elderly females had a more pronounced PP decrease compared to males; both, however, fell to the same level. White coat hypertension may explain this observation, since it is more frequent in elderly females. The implication of this observation is that physicians should take extra care in re-measuring the blood pressure and pulse pressure, especially in elderly females, in whom a more pronounced drop in pressure may be observed after a brief rest period, and thereby, result in reclassifying their risk and need for treatment.

Determinants of cardiovascular disease and sequential decision-making for treatment among women: A Heckman’s approach

•Women over age 40, from lower socio-economic status and those widowed/divorced are at elevated risk.•Diabetes, hypertension, obesity and unhealthy diet are the major risk factors.•Treatment-seeking is higher in women over age 40, from upper socio-economic status and those married.•Autonomy, accessibility, affordability and availability influence treatment-seeking behaviour.

Rationale, Design, and Baseline Characteristics of the Prospective Japan Acute Myocardial Infarction Registry (JAMIR)

BackgroundAntiplatelet therapy is a cornerstone of treatment following acute myocardial infarction (AMI). Recently, prasugrel, a new and potent antiplatelet agent, has been introduced in clinical practice. To date, however, real-world in-hospital and follow-up data in Japanese patients with AMI remain limited.ObjectivesTo examine ischemic and bleeding events in Japanese patients with AMI and the association between these events and antiplatelet therapy.MethodsThe Japan AMI Registry (JAMIR) is a multicenter, nationwide, prospective registry enrolling patients with AMI from 50 institutions. The inclusion criterion is spontaneous onset of AMI diagnosed based on either the universal definition or Monitoring Trends and Determinants in Cardiovascular disease (MONICA) criteria. The major exclusion criteria are hospital admission ≥ 24 h after onset, no return of spontaneous circulation on admission following out-of-hospital cardiopulmonary arrest, and AMI as a complication of percutaneous coronary intervention or coronary artery bypass grafting. The primary end point of the study is the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Major safety end points include major bleeding based on Thrombolysis in Myocardial Infarction (TIMI) criteria and type 3 or type 5 bleeding based on Bleeding Academic Research Consortium (BARC) criteria. Between December 2015 and May 2017, a total of 3411 patients (mean age 68.1 ± 13.2 years, 23.4% female) were enrolled in the study. Patients will be followed for 1 year.ConclusionsJAMIR will provide important information regarding contemporary practice patterns in the management of Japanese patients with AMI, their demographic and clinical characteristics, in-hospital and post-discharge outcomes, and how they are related to antiplatelet therapy.

Stroke Epidemiology in Novi Sad

Since the organization of CINDI (Countrywide Integrated Non-Communicable Disease Intervention Programme) and MONICA (Monitoring of Trends and Determinants of Cardiovascular Disease) in 1983 over the whole territory of Novi Sad community it has been found that the incidence of stroke has decreased from 2.68 to 2.36%, the mortality from 67.1 to 42.2% and the number of registered stroke survivors (morbidity prevalence) has increased almost three times. The subjects, material and methods as well as the results obtained so far are presented in this paper.

Predictive value of long-term changes of growth differentiation factor-15 over a 27-year-period for heart failure and death due to coronary heart disease.

BackgroundGrowth differentiation factor-15 (GDF-15), Cystatin C and C-reactive protein (CRP) have been discussed as biomarkers for prediction of cardiac diseases. The aim of this study was to investigate the predictive value of single and repeated measurements of GDF-15 compared to Cystatin C and CRP for incidence of heart failure (HF) and death due to coronary heart disease (CHD) in the general population.Methods and resultsLevels of GDF-15, CRP and Cystatin C were determined in three repeated measurements collected 5 years apart in the DAN-MONICA (Danish-Multinational MONitoring of trends and determinants in Cardiovascular disease) cohort (participants at baseline n = 3785). Cox regression models adjusted for cardiovascular risk factors revealed significantly increased hazard ratios (HR) for GDF-15 for incident HF 1.36 (HR per interquartile range (IQR) increase, 95% confidence interval (CI): 1.16; 1.59) and for death from CHD 1.51 (HR per IQR increase, 95% CI: 1.31, 1.75) (both with p<0.001). Joint modeling of time-to-event and longitudinal GDF-15 over a median 27-year follow-up period showed that the marker evolution was positively associated with death of CHD (HR per IQR increase 3.02 95% CI: (2.26, 4.04), p < 0.001) and HF (HR per IQR increase 2.12 95% CI: (1.54, 2.92), p<0.001). However using Cox models with follow-up time starting at the time of the third examination, serial measurement of GDF-15, modeled as changes between the measurements, did not improve prediction over that of the most recent measurement.ConclusionsGDF-15 is a promising biomarker for prediction of HF and death due to CHD in the general population, which may provide prognostic information to already established clinical biomarkers. Repeated measurements of GDF-15 displayed only a slight improvement in the prediction of these endpoints compared to a single measurement.

Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

Objectives: Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. Methods: A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population (n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. Results: IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. Conclusions: IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

Association Between Work-Related Stress and Coronary Heart Disease: A Review of Prospective Studies Through the Job Strain, Effort-Reward Balance, and Organizational Justice Models.

Work‐related stress is an example of a psychosocial risk factor that has become of interest in today's ever‐demanding, fast‐paced, and globalized society, although its link to adverse health and in particular coronary heart disease (CHD) is incompletely understood. In this review, we will

Role of Geographic Information System in Assessing Determinants of Cardiovascular Disease: An Experience From a Low- and Middle-Income Country.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. The determinants of CVD in an urban population using conventional and geographic information system techniques were attempted as a community-based census-type cross-sectional study in Kerala, India, among 1649 individuals residing in 452 households. Sociodemographic details, risk factor exposures, and self-reported disease prevalence were determined. Location of houses, wells from which subjects drew drinking water, and distances of the house from the outer road (proxy for air pollution) were mapped using differential global positioning system and pH of water samples determined. Prevalence of CVD was 5.8%. Significant predictors of CVD were male gender, diabetes mellitus, hypertension, and hypothyroidism. Statistically significant spatial association was found between CVD and groundwater pH. Geographic information system technology is useful in identification of spatial clustering and disease hotspots for designing preventive strategies targeting CVD.

G308A tumor necrosis factor-α gene polymorphism and depression in an open male population aged 25–64 years from Novosibirsk (an epidemiological study according to the WHO MONICA-psychosocial program)

Objective : to investigate the association of G308A tumor necrosis factor-α (TNF-α) (rs1800629) gene polymorphism with depression in an open male population aged 25–64 years in Novosibirsk. Patients and methods . The investigation was conducted within the framework of the WHO MONICA-psychosocial (Multinational Monitoring of Trends and Determinants of Cardiovascular Disease) program using the material of Screening III of a representative sample of 25–64-yearold men (n=657; mean age, 44.3±0.4 years; response rate, 82.1%) from an open Novosibirsk population in 1994. The depression scale (Mopsy Test) form was used to assess depression. Depression was assessed as none, moderate (MD), or severe (SD). Results . The prevalence of depression in the 25–64-year-old male population was 29% (MD, 25.9%; SD, 3.1%). There were TNF-α G/G, G/A, and A/A genotypes in 79.1, 19, and 1.9% of cases, respectively. The G allele was present in 88.6% of the men and the A allele was only in 11.4%. Comparative analysis showed that the G/A genotype was more common in men with MD (28.8%) than in those without depression (14.8%): χ2 =6.486; df=1; p=0.011; odds ratio (OR), 2.316; 95% confidence interval (CI), 1.202–4.463. The G/A genotype was also more frequently observed in individuals with depression (MD and SD, 26,5%) than in men without depression (14.8%): χ2 =5.256; df=1; p=0.022; OR, 2.072; 95% CI, 1.103–3.892 compared with G/G genotype carriers. Carriage of the A allele was more often noted in individuals with MD (17.4%) than in those without depression (8%) (χ2 =9.67; df=1; p=0.002; OR=2.43; 95% CI, 1.371–4.307; similarly, A allele carriers were more common among the individuals with MD and SD (163.6%) than among the examinees without depression (8%) (χ2 =9.122; df=1; p=0.003; OR=2.296; 95% CI, 1.325–3.98). Discussion . Analysis of the association of G308A TNF-α gene polymorphism with depression showed that although the G/G genotype proved to be most frequently found in the G308A TNF-α gene polymorphism, the heterozygous G/A genotype and the homozygous A/A genotype, the A allele were more often detected in depression. Subsequent comparative analysis confirmed that the OR for the development of MD and depression (MD and SD) in individuals with the G/A genotype was increased by 2.3 and 2 times, respectively. Conclusion . A significant association was found between depression and G308A TNF-α gene polymorphism.

Abstract P054: Endogenous Sex Hormone Levels and Endothelial Function Among Men and Post-Menopausal Women in the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Sex is a major determinant of cardiovascular disease (CVD). Endogenous sex hormones exert a variety of effects on the vascular endothelium, and changes in sex hormone levels after menopause may play a role in CVD risk in women. We hypothesized that a more androgenic sex hormone profile among post-menopausal women, but not among men, would be associated with reduced blood flow-mediated vasodilation (FMD) of the brachial artery, a marker of worse endothelial function. Methods: We examined 1396 post-menopausal women and 1707 men participating in MESA, who were free of clinical CVD at baseline. Sex hormone levels [total testosterone (T), sex hormone binding globulin (SHBG), estradiol (E2)] were measured at Exam 1 (2000-02); free T and T/E2 ratio were calculated. FMD was measured by high-resolution ultrasound. Using multivariable adjusted Poisson and linear regression methods, we tested the cross-sectional associations of sex hormones (log transformed) with FMD. Results: The mean age of men and women was 61 and 64 years, respectively. Of women, 34% were using hormone therapy (HT). Among women, after adjusting for demographics, CVD risk factors, and HT use, higher SHBG was associated with higher FMD, whereas higher free T was associated with lower FMD (Table, Model 2). In women, when examining the “best FMD response” (top decile vs. bottom 9 deciles), higher E2 was positively associated with a prevalent best response, whereas higher free T was inversely associated. Among men, a higher T/E2 ratio was marginally associated with lower FMD. Conclusion: The association between sex hormones and FMD differs in men and women. Higher E2 and SHBG and lower free T levels were associated with better FMD in post-menopausal women but not in men. Higher T/E2 ratio was associated with lower FMD in men. Further studies are needed to assess longitudinal changes in sex hormone levels and their association with vascular aging. Sex hormone levels may help identify individuals at increased CVD risk who may benefit from other risk reduction strategies.

Abstract 032: Life-Course Socioeconomic Position Relates to Higher Arterial Stiffness in Adults From the ELSA-Brasil Cohort Study

Background: Although the association between socioeconomic adversity and risk for cardiovascular disease (CVD) is established, little is known about the effect of socioeconomic disadvantages across the life-course on arterial stiffness, an important marker of subclinical cardiovascular disease (CVD). Objective: To investigate whether exposure to adverse socioeconomic position (SEP) throughout the life course and especially in early life, is associated with increased arterial stiffness in adults. In addition, we assessed whether increasing number of unfavorable SEP events during the life course is associated with higher arterial stiffness. Methods: A total of 14,497 adults from the ELSA-Brasil cohort study baseline (2008-2010), aged between 34 and 75 years (45.5% men, mean age: 51.9, SD: 9.09), with validated values of femoral carotid pulse wave velocity (cfPWV), and with information available about maternal education were included. ELSA-Brazil is a multicenter cohort of civil servants from universities and research institutions of six Brazilian cities that aims to investigate the determinants of cardiovascular disease. Arterial stiffness was measured by cfPWV. Childhood and adulthood SEP was measured by maternal education and participants’ own education, respectively. Accumulation of SEP disadvantages across the life course was evaluated using a score including maternal and participants’ own education. The following variables were used for adjustments: age, sex, race, mean arterial pressure, heart rate, smoking, physical activity, diabetes, antihypertensive use. Multiple linear regression models were used. Results: Both lower childhood and adulthood SEP were associated with higher cfPWV in adult life, although the association with childhood SEP was not independent of adulthood SEP. However, cfPWV increased with increasing number of unfavorable SEP during the life course. Individuals exposed to low SEP in childhood and adulthood presented an average increase of 0.23m/s (95% CI: 0.13-0.34) in cfPWV in relation to individuals with high SEP in both periods of life. After all adjustments this association remained statically significant (β = 0.18, 95% CI: 0.07-0.29). Conclusion: Accumulation of exposures to socioeconomic disadvantages throughout life was associated with higher cfPWV in adults. Thus, it may imply that longer exposure to social disadvantages throughout life accelerates arterial aging.

Dietary Patterns Are Associated with Cardiovascular and Cancer Mortality among Swiss Adults in a Census-Linked Cohort

Defining dietary guidelines requires a quantitative assessment of the influence of diet on the development of diseases. The aim of the study was to investigate how dietary patterns were associated with mortality in a general population sample of Switzerland. We included 15,936 participants from two population-based studies (National Research Program 1A (NRP1A) and Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)—1977 to 1993) who fully answered a simplified 24-h dietary recall. Mortality data were available through anonymous record linkage with the Swiss National Cohort (follow-up of up to 37.9 years). Multiple correspondence analysis and hierarchical clustering were used to define data-driven qualitative dietary patterns. Mortality hazard ratios were calculated for all-cause, cancer and cardiovascular mortality using Cox regression. Two patterns were characterized by a low dietary variety (“Sausage and Vegetables”, “Meat and Salad”), two by a higher variety (“Traditional”, “High-fiber foods”) and one by a high fish intake (“Fish”). Males with unhealthy lifestyle (smokers, low physical activity and high alcohol intake) were overrepresented in the low-variety patterns and underrepresented in the high-variety and “Fish” patterns. In multivariable-adjusted models, the “Fish” (hazard ratio = 0.82, 95% CI (0.68–0.99)) and “High-fiber foods” (0.85 (0.72–1.00)) patterns were associated with lower cancer mortality. In men, the “Fish” (0.73 (0.55–0.97)) and “Traditional” (0.76 (0.59–0.98)) patterns were associated with lower cardiovascular mortality. In summary, our results support the notion that dietary patterns affect mortality and that these patterns strongly cluster with other health determinants.