Early-onset Cardiovascular Disease Research Articles

Preoperative Counseling and Surgical Practice: Gynecologic Surgeons' Approach to Ovary-Sparing Hysterectomy [ID 2683432

INTRODUCTION: Since the early 20th century, surgical practices on prophylactic oophorectomy at the time of hysterectomy have fluctuated. This study aims to assess how current gynecologic surgeons are counseling patients on ovary-sparing benign hysterectomies and assess any gaps in provider knowledge. METHODS: Institutional review board exception was obtained. A survey was piloted and underwent several rounds of editing before being sent to members of American Association of Gynecologic Laparoscopists (AAGL) in April 2023. The questionnaire evaluated preoperative counseling on risks and benefits of ovary-sparing hysterectomy for benign indications and surgical practices for when to perform bilateral salpingectomy and oophorectomy. Descriptive statistics and regression analyses were performed. RESULTS: The survey was sent out by email to 6,622 AAGL members, 3,576 opened the email, and 520 completed surveys (14% response rate). Approximately one-half (58%) completed subspeciality training. Most counsel patients on the benefits of ovarian conservation including the prevention of osteoporosis (88%), early onset menopause (87%), cardiovascular disease (84%), and dementia (52%). Fifty percent recommend routine bilateral salpingo-oophorectomy at time of hysterectomy starting at age 61, whereas 38% recommend this be performed at age 51–55 years. CONCLUSION: Gynecologic surgeons are counseling patients on the risks and benefits of ovarian conservation. How frequently ovary-sparing hysterectomies are offered and the age at which bilateral salpingo-oophorectomy is recommended vary by provider. Additional high-quality studies are needed to further understand the optimal timing of oophorectomy at time of benign hysterectomy, and there is also a need for provider education to minimize discrepancy in practice patterns.

Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial.

Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care. Participants were recruited at a single academic medical center. Those aged 8-30years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6months. Sixty-three participants were enrolled (57% male; mean age: 18 ± 4years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6months (- 2.3mmHg; 95% CI - 6.5, 1.8 vs. 3.0mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12). Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

Multigenerational diabetes mellitus.

Gestational diabetes (GDM) changes the maternal metabolic and uterine environment, thus increasing the risk of short- and long-term adverse outcomes for both mother and child. Children of mothers who have GDM during their pregnancy are more likely to develop Type 2 Diabetes (T2D), early-onset cardiovascular disease and GDM when they themselves become pregnant, perpetuating a multigenerational increased risk of metabolic disease. The negative effect of GDM is exacerbated by maternal obesity, which induces a greater derangement of fetal adipogenesis and growth. Multiple factors, including genetic, epigenetic and metabolic, which interact with lifestyle factors and the environment, are likely to contribute to the development of GDM. Genetic factors are particularly important, with 30% of women with GDM having at least one parent with T2D. Fetal epigenetic modifications occur in response to maternal GDM, and may mediate both multi- and transgenerational risk. Changes to the maternal metabolome in GDM are primarily related to fatty acid oxidation, inflammation and insulin resistance. These might be effective early biomarkers allowing the identification of women at risk of GDM prior to the development of hyperglycaemia. The impact of the intra-uterine environment on the developing fetus, "developmental programming", has a multisystem effect, but its influence on adipogenesis is particularly important as it will determine baseline insulin sensitivity, and the response to future metabolic challenges. Identifying the critical window of metabolic development and developing effective interventions are key to our ability to improve population metabolic health.

Role of Retinol Binding Protein -4(RBP-4) and some Biochemical Parameters in Type II Diabetes Mellitus Patients

Diabetes is an important public health issue that adversely affects the lives of millions of individuals worldwide. RBP4 involvement in the pathogenesis of insulin resistance and type 2 diabetes. The aim of this study to assessment of role retinol binding protein -4 and other biochemical parameters in T2DM. Eighty eight participated in this study. Forty four T2DM, age between (40-60) years and forty four healthy control age between (40-55). there was a highly significant increase of FBS, HbA1C, TC, TG, LDL-C and VLDL-C, while a significant decreased of HDL-C between control and T2DM patients. There was a highly significant increase of RBP-4 level between different group (control and T2DM patients). Conclusion: Elevation of retinol in diabetic patients is considered a risk indicator for them with the early onset of cardiovascular disease, and this is a result of the continuous increase in the concentrations of sugar levels in the blood, and thus a defect in the metabolism of fats occurs, which leads to its rise, and this is an indicator of the entry of a diabetic patient with one of the complications, which is heart disease.

Sibling Death in Childhood and Early Adulthood and Risk of Early-Onset Cardiovascular Disease

Sibling death is a highly traumatic event, but empirical evidence on the association of sibling death in childhood and early adulthood with subsequent risk of incident cardiovascular disease (CVD) remains limited. To evaluate the association between sibling death in the early decades of life and subsequent risk of incident early-onset CVD. This population-based cohort study included 2 098 659 individuals born in Denmark from 1978 to 2018. Follow-up started at age 1 year or the date of the first sibling's birth, whichever occurred later, and it ended at the first diagnosis of CVD, the date of death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 1, 2021, through January 10, 2022. The death of a sibling. The outcome was early-onset CVD. Cox models were used to estimate hazard ratios (HRs) with 95% CIs. This study included 2 098 659 individuals (1 076 669 [51.30%] male; median [IQR] age at death of sibling, 11.48 [4.68-21.32] years). During the median (IQR) follow-up of 17.52 (8.85-26.05) years, 1286 and 76 862 individuals in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD. Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR, 1.17; 95% CI, 1.10-1.23; cumulative incidence in bereaved individuals, 1.96% [1.61%-2.34%]; cumulative incidence in nonbereaved individuals at age 41 years, 1.35% [1.34%-1.37%]; cumulative incidence difference: 0.61% [95% CI, 0.24%-0.98%]). Increased risks were also observed for most type-specific CVDs, in particular for myocardial infarction (HR, 1.66; 95% CI, 1.12-2.46), ischemic heart disease (HR, 1.52; 95% CI, 1.22-1.90), and heart failure (HR, 1.50; 95% CI, 1.00-2.26). The association was observed whether the sibling died due to CVD (HR, 2.54; 95% CI, 2.04-3.17) or non-CVD (HR, 1.13; 95% CI, 1.06-1.19) causes. The increased risk of CVD was more pronounced for individuals who lost a twin or younger sibling (HR, 1.25; 95% CI, 1.15-1.36) than an elder sibling (HR, 1.11; 95% CI, 1.03-1.20). In this cohort study of the Danish population, sibling death in childhood and early adulthood was associated with increased risks of overall and most type-specific early-onset CVDs, with the strength of associations varying by cause of death and age difference between sibling pairs. The findings highlight the need for extra attention and support to the bereaved siblings to reduce CVD risk later in life.

Molecular and clinical aspects relevant for counseling individuals with clonal hematopoiesis of indeterminate potential.

Clonal hematopoiesis of indeterminate potential (CHIP) has fascinated the medical community for some time. Discovered about a decade ago, this phenomenon links age-related alterations in hematopoiesis not only to the later development of hematological malignancies but also to an increased risk of early-onset cardiovascular disease and some other disorders. CHIP is detected in the blood and is characterized by clonally expanded somatic mutations in cancer-associated genes, predisposing to the development of hematologic neoplasms such as MDS and AML. CHIP-associated mutations often involve DNA damage repair genes and are frequently observed following prior cytotoxic cancer therapy. Genetic predisposition seems to be a contributing factor. It came as a surprise that CHIP significantly elevates the risk of myocardial infarction and stroke, and also contributes to heart failure and pulmonary hypertension. Meanwhile, evidence of mutant clonal macrophages in vessel walls and organ parenchyma helps to explain the pathophysiology. Besides aging, there are some risk factors promoting the appearance of CHIP, such as smoking, chronic inflammation, chronic sleep deprivation, and high birth weight. This article describes fundamental aspects of CHIP and explains its association with hematologic malignancies, cardiovascular disorders, and other medical conditions, while also exploring potential progress in the clinical management of affected individuals. While it is important to diagnose conditions that can lead to adverse, but potentially preventable, effects, it is equally important not to stress patients by confronting them with disconcerting findings that cannot be remedied. Individuals with diagnosed or suspected CHIP should receive counseling in a specialized outpatient clinic, where professionals from relevant medical specialties may help them to avoid the development of CHIP-related health problems. Unfortunately, useful treatments and clinical guidelines for managing CHIP are still largely lacking. However, there are some promising approaches regarding the management of cardiovascular disease risk. In the future, strategies aimed at restoration of gene function or inhibition of inflammatory mediators may become an option.

Age at cardiovascular disease onset, dementia risk, and the role of lifestyle factors.

We first examined the role of age at cardiovascular disease (CVD) onset for incident dementia, and then examined whether lifestyle factors at guideline-recommended levels in individuals with CVD mitigates dementia risk. We used population-based data (Whitehall II: n=10,308/baseline 1985-1988/examinations every 4-5 years). Lifestyle factors (non-smoking, body mass index [BMI], physical activity, diet) were extracted post-CVD. Over a median of 31.6 years, 3275 (32.1%) developed CVD. At age 70, risk of dementia was higher in individuals with CVD onset before (hazard ratio [HR] of incident dementia for participants with CVD before age 60, using participants without CVD at age 70 as the reference: 1.56, 95% confidence interal [CI] 1.18-2.08) but not after 60 years. In participants with CVD, a greater number of lifestyle factors at recommended levels post-CVD was associated with a lower dementia risk (per lifestyle factor at recommended level HR: 0.73, 95% CI 0.59-0.92). Our results suggest that early onset CVD is associated with a higher dementia risk at older ages. In those with CVD, the dementia risk was lower if lifestyle factors are at recommended levels following CVD diagnosis. CVD in midlife but not in late life is associated with a higher risk of dementia. Dementia risk in CVD patients is lower if their lifestyle factors are at recommended levels. These findings provide evidence to promote CVD prevention in midlife or earlier. Study findings also show the importance of a healthy lifestyle in those with CVD.

Functional characterization of missense variants affecting the extracellular domains of ABCA1 using a fluorescence-based assay

Excess cholesterol originating from nonhepatic tissues is transported within HDL particles to the liver for metabolism and excretion. Cholesterol efflux is initiated by lipid-free or lipid-poor apolipoprotein A1 interacting with the transmembrane protein ABCA1, a key player in cholesterol homeostasis. Defective ABCA1 results in reduced serum levels of HDL cholesterol, deposition of cholesterol in arteries, and an increased risk of early onset CVD. Over 300 genetic variants in ABCA1 have been reported, many of which are associated with reduced HDL cholesterol levels. Only a few of these have been functionally characterized. In this study, we have analyzed 51 previously unclassified missense variants affecting the extracellular domains of ABCA1 using a sensitive, easy, and low-cost fluorescence-based assay. Among these, only 12 variants showed a distinct loss-of-function phenotype, asserting their direct association with severe HDL disorders. These findings emphasize the crucial role of functional characterization of genetic variants in pathogenicity assessment and precision medicine. The functional rescue of ABCA1 loss-of-function variants through proteasomal inhibition or by the use of the chemical chaperone 4-phenylbutyric acid was genotype specific. Genotype-specific responses were also observed for the ability of apolipoprotein A1 to stabilize the different ABCA1 variants. In view of personalized medicine, this could potentially form the basis for novel therapeutic strategies.

Menopausal age and cardiovascular disease risk in American women: evidence from the National Health and Nutrition Examination Survey

Objective Cardiovascular disease (CVD) is a significant contributor to the deaths of females, and premature menopause adds to the risk of CVD in females. Therefore, our study aimed to investigate the age of menopause and CVD incidence in American females using data from the National Health and Nutrition Examination Survey (NHANES). Method We analyzed data from 6347 females to investigate the association between menopausal age and the risk of CVD using multivariate logistic regression analysis. Results The study found that a later menopausal age reduces the risk of developing CVD (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.63 − 0.88, p < 0.001). Moreover, females with early-onset CVD had an increased risk of premature menopause before the age of 40 years (OR = 2.44, 95% CI = 1.60 − 3.72, p < 0.001). Conclusion Menopausal age is associated with the risk of developing CVD in American females. Specifically, if menopause occurs earlier, there is an increased risk of CVD. Additionally, early-onset CVD significantly raises the risk of premature menopause, which in turn has important implications for female reproductive health.

What is the true nature of the relationship between metabolic disturbance, specifically of glucose and insulin metabolism, and depressive and other mood disorders?

Much attention in recent years has focused on the extent to which the risk of metabolic disturbances, and most fundamentally of glucose and insulin, are prevalent among those treated for depressive and other mood disorders (Osimo et al., 2021; Scott et al., 2019; Tickell et al., 2022). Public concern has also focused on the increased rates of premature mortality in those with chronic depression and other major mental disorders, with a significant proportion of that risk being due to early-onset cardiovascular disease (particularly among women). A common assumption is that much of this risk is a consequence of medical treatments for depression, and their possible adverse effects such as increased risk of diabetes, presumably mediated by long-term weight gain.

Circulating Cytokine Levels and Cardiovascular Disease Risk Profile in Young Adult Offspring of Women with Type1 Diabetes.

Cytokines are key players in the development of both type1 diabetes (T1D) and cardiovascular disease (CVD). Offspring of women with T1D are known to have an increased risk of early-onset CVD. We studied whether an increased risk of CVD can be observed in the cytokine profile among young adult offspring of women with T1D. This cross-sectional case-control study included 67 offspring of women with T1D (cases) and 79 control participants (controls). At an age of 18-23years, they participated in a clinical assessment including laboratory tests and questionnaires. Cytokine levels were analyzed from venous blood samples after 10h fasting using Quansys biosciences Q-Plex™ High Sensitivity Human Cytokine Array. Circulating cytokine levels were in general similar between the groups. The circulating levels of interferon-γ (1.78 [IQR 1.20, 2.36] pg/mL versus 2.57 [IQR 1.50, 3.89] pg/mL) (p = 0.006) were lower in cases than controls. The findings did not support our hypothesis that serum cytokine profile, determined in early adulthood, was associated with a more adverse CVD risk profile in offspring of women with T1D. Further studies are warranted to find out whether cytokines could serve as early biomarkers of CVD development or whether changes in the cytokine levels over years could be used to monitor CVD progression in offspring of women with T1D.

0757 Associations between Objective Sleep Health and Cardiovascular Health in Adolescents with Type 1 Diabetes

Abstract Introduction Adolescents with type 1 diabetes (T1D) are at risk for early-onset cardiovascular disease due to increased arterial stiffness, decreased endothelial function, and early-stage hypertension compared to healthy peers. Poor sleep health has been associated with greater glycemic variability, increased insulin resistance, and poorer cardiovascular health; however, the relationship between sleep and vascular health has not been studied in adolescents with T1D. The aim of this study was to evaluate associations between objectively measured sleep and cardiovascular health in this population. We hypothesized that better sleep health would correlate with better cardiovascular health. Methods Twenty-four adolescents with T1D completed the study during the academic year. Sleep was monitored for one week at home with actigraphy. Watchpat-assessed apnea hypopnea index (AHI) and vascular measures were obtained during an overnight study visit. EndoPAT estimated reactive hyperemia index (RHI) and augmentation index (AI). Dynapulse measured systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), heart rate (HR), pulse wave velocity (PWV), and brachial distensibility and resistance (BrachD, BrachR). Correlations between sleep and vascular measures were examined. Results Participants were an average age of 15.5±1.1 years (54.2% female, 83.3% White non-Hispanic, BMI 58.8 ±25.8%ile, HbA1c 7.5±1.2%). Average school night (weekday) sleep duration was 6.7±0.8 hours and average sleep efficiency (SE) was 82.8±6.9%. The majority (87.5%) of participants slept less than the clinical recommendation of 8-10 hours per night. Worse actigraphy-estimated SE was associated with higher DBP (r=-0.52, p=0.02; mean= 59.2±6.7mmHg) and MAP (r=-0.46, p=0.04; mean= 79.5±7.5mmHg). Higher AHI was associated with higher BrachR (r=0.81, p&amp;lt; 0.001). No significant associations were identified between sleep variables and RHI, AI, HR, PWV, or BrachD (all p&amp;gt;0.05). Conclusion Poorer SE and higher AHI were associated with poorer indicators of vascular health in adolescents with T1D, consistent with prior literature linking poorer sleep health with risk factors for hypertension in adults with T1D. Further research is needed to determine if improving sleep can improve cardiovascular comorbidities in adolescents with T1D. Support (if any) JDRF 2-SRA-2019-848-S-B; JDRF 2-SRA-2022-1144-M-B; Ludeman Center for Women’s Health Research COVID-19 Relief Supplemental Grant; Colorado Clinical &amp; Translational Research Center Maternal &amp; Child Health Pilot Award; CTSA UL1 TR002535

Clinical and genetic variants of hypertriglyceridemia in the practice of a lipidologist

Background. An important role in identifying the causes and determining the prognostic significance of dyslipidemia belongs to the level of triglycerides. High triglycerides are a risk factor for the development or early onset of cardiovascular disease.&#x0D; Aim. To assess the frequency of detection and causes of hypertriglyceridemia among patients receiving outpatient appointments with a lipidologist.&#x0D; Material and methods. An analysis of lipid metabolism disorders in patients of the Adult Lipidology Center was carried out: 1233 people aged 1884 years, including 777 (63%) women and 456 (37%) men. Examination of patients with dyslipidemia included an examination by a cardiologist-lipidologist (with the calculation of the risk of cardiovascular complications), an assessment of the probability of familial hypercholesterolemia according to the British scale and the criteria of the Dutch lipid clinics, a biochemical blood test, an analysis of the thyroid status, the content of glycated hemoglobin, extracranial duplex scanning, according to indications echocardiography. Biomaterial samples from 421 patients with the phenotype of inherited dyslipidemia were examined by next generation sequencing to identify the carriage of APOE gene isoforms, as well as genes associated with familial hypercholesterolemia (LDLR, LDLRAP1, APOB, PCSK9). For statistical processing of research data, descriptive statistics methods were used. In a non-parametric distribution, data were expressed as Me (Q1; Q3). When performing statistical processing of the obtained data, nonparametric tests (MannWhitney test, when comparing qualitative data 2 and Fisher's exact test, odds ratio and relative risk) were used. The value of p 0.05 was taken as a criterion of significance. The nature of the data distribution was assessed using the KolmogorovSmirnov test.&#x0D; Results. Elevated triglyceride levels were detected in 341 (27.66%) patients: 220 (64.5%) women and 121 (35.5%) men. Mild degree of hypertriglyceridemia occured in 42.5% of cases, moderate in 42.5%, severe in 7.6%, extremely severe in 7.4%. The genetic characteristics of patients with hypertriglyceridemia were determined, and 1 previously undescribed variant of the APOE mutation was found.&#x0D; Conclusion. The most common forms of hypertriglyceridemia were mild and moderate, the most common variants of APOE mutations were p.Cys130Arg and p.Arg176Cys.

Piezoelectric Metamaterial Blood Pressure Sensor

Continuous blood pressure monitoring allows for detecting the early onset of cardiovascular disease and assessing personal health status. Conventional piezoelectric blood pressure monitoring techniques have the ability to sense biosignals due to their good dynamic responses but have significant drawbacks in terms of power consumption, which limits the operation of blood pressure sensors. Although piezoelectric materials can be used to enhance the self-powered blood pressure sensor responses, the structure of the piezoelectric element can be modified to achieve a higher output voltage. Here, a structural study on piezoelectric metamaterials in blood pressure sensors is demonstrated, and output voltages are computed and compared to other architectures. Next, a Bayesian optimization framework is defined to get the optimal design according to the metamaterial design space. Machine learning algorithms were used for applying regression models to a simulated dataset, and a 2D map was visualized for key parameters. Finally, a time-dependent blood pressure was applied to the inner surface of an artery vessel inside a 3D tissue skin model to compare the output voltage for different metamaterials. Results revealed that all types of metamaterials can generate a higher electric potential in comparison to normal square-shaped piezoelectric elements. Bayesian optimization showed that honeycomb metamaterials had the optimal performance in generating output voltage, which was validated according to regression model analysis resulting from machine learning algorithms. The simulation of time-dependent blood pressure in a 3D skin tissue model revealed that the design suggested by the Bayesian optimization process can generate an electric potential more than two times greater than that of a conventional square-shaped piezoelectric element.

Dielectric modulation strategy of carbon nanotube field effect transistors based pressure sensor: towards precise monitoring of human pulse

Continuous monitoring of arterial pulse has great significance for detecting the early onset of cardiovascular disease and assessing health status, while needs pressure sensors with high sensitivity and signal-to-noise ratio (SNR) to accurately capture more health information concealed in pulse waves. Field effect transistors (FETs) combined with the piezoelectric film is an ultrahigh sensitive pressure sensor category, especially when the FET works in the subthreshold regime, where the signal enhancement effect on the piezoelectric response is the most effective. However, controlling the work regime of FET needs extra external bias assistance which will interfere with the piezoelectric response signal and complicate the test system thus making the scheme difficult to implement. Here, we described a gate dielectric modulation strategy to match the subthreshold region of the FET with the piezoelectric output voltage without external gate bias, finally enhancing the sensitivity of the pressure sensor. A carbon nanotube field effect transistor and polyvinylidene fluoride (PVDF) together form the pressure sensor with a high sensitivity of 7 × 10−1 kPa−1 for a pressure range of 0.038–0.467 kPa and 6.86 × 10−2 kPa−1 for a pressure range of 0.467–15.5 kPa, SNR, and the ability to continuously monitor pulse in real-time. Additionally, the sensor enables high-resolution detection of weak pulse signals under large static pressure.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Toward Real-Time Blood Pressure Monitoring via High-Fidelity Iontronic Tonometric Sensors with High Sensitivity and Large Dynamic Ranges.

Continuous, noninvasive blood pressure (CNIBP) monitoring provides valuable hemodynamic information that renders detection of the early onset of cardiovascular diseases. Wearable mechano-electric pressure sensors that mount on the skin are promising candidates for monitoring continuous blood pressure (BP) pulse waveforms due to their excellent conformability, simple sensing mechanisms, and convenient signal acquisition. However, it is challenging to acquire high-fidelity BP pulse waveforms since it requires highly sensitive sensors (sensitivity larger than 4 × 10-5 kPa-1 ) that respond linearly with pressure change over a large dynamic range, covering the typical BP range (5-25kPa). Herein, this work introduces a high-fidelity, iontronic-based tonometric sensor (ITS) with high sensitivity (4.82 kPa-1 ), good linearity (R2 > 0.995), and a large dynamic range (up to 180% output change) over a broad working range (0 to 38kPa). Additionally, the ITS demonstrates a low limit of detection at 40Pa, a fast load response time (35ms) and release time (35ms), as well as a stable response over 5000 load per release cycles, paving ways for potential applications in human-interface interaction, electronic skins, and robotic haptics. This work further explores the application of the ITS in monitoring real-time, beat-to-beat BP by measuring the brachial and radial pulse waveforms. This work provides a rational design of a wearable pressure sensor with high sensitivity, good linearity, and a large dynamic range for real-time CNIBP monitoring.

Benefits of Whey Proteins on Type 2 Diabetes Mellitus Parameters and Prevention of Cardiovascular Diseases.

Type 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality, and it is a major risk factor for the early onset of cardiovascular diseases (CVDs). More than genetics, food, physical activity, walkability, and air pollution are lifestyle factors, which have the greatest impact on T2DM. Certain diets have been shown to be associated with lower T2DM and cardiovascular risk. Diminishing added sugar and processed fats and increasing antioxidant-rich vegetable and fruit intake has often been highlighted, as in the Mediterranean diet. However, less is known about the interest of proteins in low-fat dairy and whey in particular, which have great potential to improve T2DM and could be used safely as a part of a multi-target strategy. This review discusses all the biochemical and clinical aspects of the benefits of high-quality whey, which is now considered a functional food, for prevention and improvement of T2DM and CVDs by insulin- and non-insulin-dependent mechanisms.

Abstract P457: Healthful Lifestyle Factors and Incidence of Early Onset Cardiovascular Disease in the Million Veteran Program

Background and Objective: While previous studies have reported benefits of healthful and modifiable lifestyle factors on the incidence of cardiovascular disease (CVD) among adults, it is unclear whether adhering to healthful lifestyle factors is associated with a lower risk of CVD among young adults. Thus, the purpose of this study is to examine the association of low-risk lifestyle factors including normal weight, regular exercise, not smoking, adequate sleep, and a healthy diet with risk of early onset CVD in the Veterans Affairs (VA) Million Veteran Program (MVP). Methods: The study cohort included 49,603 MVP participants with self-reported and electronic health records information on the five low-risk lifestyle factors. Assigning values to each lifestyle factor, we created a score that ranges from 2 to 15 with higher scores indicating a healthier lifestyle. The association between low-risk lifestyle factors and fatal and non-fatal CVD was assessed using Cox proportional hazard model adjusted for age, sex, race, education, income, marital status, alcohol use, total energy intake, diabetes, hypertension, and hypercholesterolemia. Results: The mean age was 47 years and 37 % were women. After a follow-up period of 3.1 years, we documented 655 early onset CVD events with an overall crude annual incident rate of 3.5‰ among women and 3.9‰ among men. In Cox proportional hazard model adjusted for confounders, a higher low-risk lifestyle score was associated with a lower risk of early onset CVD [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.33-0.56, comparing extreme score, Figure]. Conclusion: Our data show an inverse and graded association of healthful lifestyle factors with risk of early onset CVD among young veterans, suggesting that adherence to low-risk lifestyle factors including not smoking, sufficient sleep, normal weight, and regular exercise may help prevent early onset CVD.

Abstract P130: CVD Risk Factors Among Young People in Haiti: Implications for Low-Income Countries

Introduction: Over 80% of the global cardiovascular disease (CVD) burden is in low-income countries, including Haiti. Emerging data from these settings indicate CVD risk factors occur earlier in the life-course, but our knowledge of the age of onset and associated factors is limited. This study provides the first population-based estimates of CVD risk factors among young people ages 18-30 years in Haiti. Hypothesis: We hypothesized that elevated blood pressure (pre-hypertension (SBP/DBP &gt;120-140/80-89) or hypertension (SBP/DBP &gt;140/90 or on treatment) is the most common CVD risk factor among young people ages 18-30 years with an estimated prevalence &gt;15%. Methods: This is a cross-sectional analysis within the Haiti CVD Cohort Study, a population-based longitudinal study of adults ≥18 years in Port au Prince. Participants were enrolled between March 2019-April 2021 using multistage random sampling. At enrollment, sociodemographic and health behaviors were assessed coupled with a physical exam and laboratory measures. CVD risk factors included: elevated BP, dyslipidemia (LDL-C ≥100mg/dL), kidney disease (urine albumin creatinine ratio (ACR) or estimated glomerular filtration rate (eGFR)), obesity (BMI &gt; 30kg/m 2 ), and smoking, alcohol use, and physical activity using the WHO STEPS survey. Results: Among 957 participants ages 18-30 years, median age was 24 years (IQR 21-27) and 52% were female. Prevalence of elevated BP was 23% (20% pre-hypertension, 3% hypertension), 34% dyslipidemia, 5% ACR ≥30mg/g, 0.21% eGFR &lt; 60 mL/min/1.73, and 7% obese. Other CVD risk factors include: 4% were current smokers, 6% reported any lifetime tobacco use, 19% reported one or more alcoholic drinks per day, and 47% reported low physical activity. Compared to participants ages 18-24 years, those ages 25-30 years had higher odds of pre-hypertension/hypertension (aOR=1.56, 95% CI: 1.13-2.15), but lower odds of dyslipidemia (aOR=0.55, 95% CI: 0.41-0.74). Females had lower odds of pre-hypertension/hypertension (aOR= 0.24, 95% CI: 0.17-0.35) and dyslipidemia (aOR=0.47, 95% CI: 0.35-0.64). Being obese was associated with a higher odds of pre-hypertension/hypertension (aOR=2.21, 95% CI: 1.14-4.16) but lower odds of dyslipidemia (aOR= 0.35, 95%CI: 0.20-0.61) compared to normal weight. Conclusion: These data provide previously unknown population-based estimates of CVD risk factors among young people in a low-income country. Rates of elevated BP and dyslipidemia are alarmingly high and occur prematurely in the life-course in this cohort and are associated with risk of future CVD events and mortality. Despite low prevalence of smoking and drinking alcohol, smoking tobacco was still associated with an increased odds of dyslipidemia. Additional drivers of early-onset CVD risk factors must be identified to guide targeted interventions for primordial and primary prevention as well as treatment.