Established Cardiovascular Disease Risk Factors Research Articles

Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: a national cohort study

Abstract Background/Purpose Recent studies show that early life stress is associated with later risk of cardiovascular disease (CVD) and stress may also increase the risk of psychiatric disease. We investigated the association between non-psychotic mental disorders in adolescence and subsequent myocardial infarction, and the role of stress resilience and physical fitness in this association. Method This is a register-based cohort study with 238 013 males born between 1952 and 1956 followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semi-structured interview with a psychologist. Physical fitness was measured at conscription examination with a cycle ergometer test. A total of 34 503 men were diagnosed with a non-psychotic mental disorder at conscription. Using Cox regression, we estimated the association of mental disorders with myocardial infarction after adjustment for other established CVD risk factors in adolescence. Stress resilience and physical fitness were included in the adjusted model in a second set of analyses. Results A total of 5891 diagnoses of first myocardial infarction were identified. Non-psychotic mental disorders were associated with an increased risk of myocardial infarction, with a hazard ratio (HR) and confidence interval (CI) of 1.51 (1.41–1.62). The association remained statistically significant after adjustment for other important potential confounders in adolescence such as systolic and diastolic blood pressure, body mass index, inflammation, cognitive function, parental socioeconomic index and a summary disease score (HR 1.24 (CI 1.13–1.35)). The association was further explained by stress resilience and lifestyle factors assessed with a cardiovascular fitness test in adolescence, as the association attenuated but remained statistically significant when further adjusting for stress resilience and physical fitness (HR 1.18 (CI 1.08–1.29)). Conclusion A non-psychotic mental disorder in adolescences may increase the risk of developing myocardial infarction later in life. This association was partly but not completely explained by poorer stress resilience and physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress in early life. Funding Acknowledgement Type of funding source: None

Association between serum lipids, polyunsaturated fatty acids, and prognosis in maintenance hemodialysis patients.

Risks of mortality and cardiovascular disease (CVD) are significantly higher in hemodialysis (HD) patients than in the general population, where dyslipidemia is an established risk factor for CVD and mortality. There is no clear conclusion, however, whether dyslipidemia is a significant risk factor for CVD and mortality in HD patients. Similarly, the association between the polyunsaturated fatty acids (PUFAs) and the mortality is not clear in HD patients. We retrospectively investigated mortality and CVD events in 420 HD patients. We classified patients into high- and low-lipid groups depending on their lipid levels. Survival rates were calculated using the Kaplan-Meier analysis and evaluated by the log-rank test. The risk estimates were computed using a multivariate Cox proportional hazard analysis. During their follow-up (June 2011 to June 2016), 151 patients died (37 of CVD), and 112 patients experienced new CVD events. On Kaplan-Meier analysis, the number of all-cause deaths and CVD events were significantly higher in the low HDL-cholesterol group (P < 0.01, log-rank test). Similarly, the number of all-cause deaths was significantly higher in the high eicosapentaenoic acid/arachidonic acid ratio group (P < 0.01, log-rank test). Multivariate Cox proportional analysis showed that HDL-cholesterol was a significant prognostic indicator for new onset of CVD events (low: 0, high: 1, hazard ratio 0.66, 95% confidence interval 0.44-0.97; P = 0.04). In HD patients, LDL-cholesterol and non-HDL-cholesterol levels are not associated with mortality or CVD events. The HDL-cholesterol level, however, is an independent predictor of new CVD events even in HD patients.

Examining healthcare professionals\u2019 beliefs and actions regarding the physical health of people with schizophrenia

BackgroundPeople with schizophrenia have a higher premature mortality risk compared with the general population mainly due to cardiovascular disease (CVD). Despite this, people with schizophrenia are less likely to access physical health services or have their physical health investigated and monitored.AimsTo examine the beliefs and actions of mental health professionals regarding the physical health of people with schizophrenia.MethodTwo hundred and fifty-five healthcare professionals who support people with schizophrenia within Greater Manchester Mental Health NHS Foundation Trust (GMMH), United Kingdom and Pennine Care NHS Foundation Trust (PCFT), United Kingdom took part. Beliefs and actions were assessed using a self-administered questionnaire, which was constructed around two primary domains (1) CVD risk factors; and (2) physical health interventions. Descriptive statistics were reported and responses between different healthcare professional groups were compared.ResultsThe overwhelming majority of participants were aware of established CVD risk factors with 98% identifying family history of CVD, 98% for smoking and 96% for high blood pressure. Most participants believed nearly all healthcare professionals were responsible for monitoring the physical health of people with schizophrenia, regardless of job speciality. There were 67% of participants who reported delivering an intervention to improve sedentary behaviour for people with schizophrenia. However, awareness of government and NHS recommended lifestyle interventions were low.ConclusionsThis study found good knowledge regarding many established CVD risk factors but little clarity regarding who is responsible for monitoring the physical health of people with schizophrenia and how often brief lifestyle interventions are being implemented.

Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Disease.

The purpose of this review article is to summarize the preclinical and clinical evidence supporting the notion of clonal hematopoiesis of indeterminate potential (CHIP), highlight current knowledge gap, and provide future directions. Epidemiological studies show that advanced age is a major risk factor for the development of cardiovascular disease (CVD) and cancer, the two leading causes of morbidity and mortality worldwide. While the negative effect of aging on CVD is a reflection of cumulative exposure to various established traditional CVD risk factors, genetic sequencing of whole blood-derived DNA recently revealed that clonal mutations in myeloid stem cells are associated with higher risks of cardiovascular events and hematopoietic malignancies. The clinical repercussions of this biological state, termed CHIP, are increasingly appreciated. Historically, CHIP has been associated with an increased risk of hematological malignancies. However, new research is showing that CHIP is also associated with an increased risk of several cardiac-related conditions, including atherosclerosis, myocardial infarction, aortic valve stenosis, and congestive heart failure. CHIP is increasingly being appreciated worldwide as a CVD risk factor, and further studies are needed to better understand the complex relationship between these two disorders.

Immediate post-exercise blood pressure and arterial compliance in middle-aged and older normotensive females: A cross-sectional study

This study examined whether immediate post-exercise systolic blood pressure (SBP) is associated with arterial compliance in middle-aged and older normotensive females. A total of 548 normotensive, non-frail females aged 55 years and older with no previous history of cardiovascular disease (CVD) participated in this cross-sectional study. Large and small arterial compliance were assessed by pulse wave analysis. Reduced arterial compliance was defined based on age and sex cutoffs. SBP was measured at rest and immediately following a 3-min moderate step-test. CVD risk factors were also assessed (e.g. resting systolic and diastolic BP, fasting glucose, triglycerides, cholesterol, body mass index). A total of 15.1% and 44.0% of the participants showed reduced large and small artery compliance, respectively. Immediate post-exercise SBP was associated with reduced large (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.01–1.04; p = 0.010) and small (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.00–1.03; p = 0.008) arterial compliance. Participants with highest immediate post-exercise SBP (quartile 4; i.e. ≥ 165 mmHg) showed increased odds ratios for reduced large (2.67, 95%CI 1.03–6.94; p = 0.043) and small (2.27, 95%CI 1.22–4.21; p = 0.010) arterial compliance compared to those with the lowest immediate post-exercise SBP (quartile 1; i.e. ≤ 140 mmHg), independent of other established CVD risk factors. Immediate post-exercise SBP following a brief moderate step-test seems to be able to discriminate reduced arterial compliance in middle-aged and older normotensive females.

The association between job strain, depressive symptoms, and cardiovascular disease risk: results from a cross-sectional population-based study in Québec, Canada.

Job strain (high psychological demands and low decision control) has been associated with cardiovascular disease (CVD). It is unclear if job strain is associated with CVD risk score independently of depression, an established risk factor for CVD. This study investigated whether there is an association between job strain and CVD risk score, when depressive symptoms are controlled for. Sex differences were examined. Data came from the CARTaGENE study, a community health survey of adults in Québec, Canada (n = 7848). Participants were working adults aged 40-69years. CVD risk was estimated using the Framingham risk score. Job strain was measured as the ratio of job demands to control using the Job Content Questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression analyses were conducted to examine the association between job strain and CVD risk score controlling for depressive symptoms. There was no interaction effect between job strain and depressive symptoms in the association with CVD risk score. High job strain was reported in approximately 21% of participants, high Framingham risk score was observed in approximately 9%. Job strain was associated with the Framingham risk score (B = 0.73, p < 0.001, adjusted for age, sex, and education) and controlling for depressive symptoms did not significantly change the association (B = 0.59, p < 0.001). The results suggest that the job strain is associated with CVD risk score and that this association is not explained by depressive symptoms. Similar associations were observed for males and females.

Effect of adiposity on differences in carotid plaque burden in studies conducted in Norway and Russia: a cross-sectional analysis of two populations at very different risk of cardiovascular mortality.

ObjectivesLarge differences exist in the burden of cardiovascular disease (CVD) between Russia and Western European countries including Norway. Obesity prevalence may contribute to the differences. We investigated whether difference in the level of adiposity, assessed using body mass index and waist-to-hip ratio(WHR), could explain intercountry differences in the burden of carotid plaque, a measure of atherosclerosis, in the populations.DesignCross-sectional analysis. Logistic and linear regression models were used.SettingWe used population-based cross-sectional Know Your Heart (KYH) study in Russia and the Tromsø 7 study (Tromsø 7) in Norway.Participants3262 and 1800 men and women aged 40–69 years in KYH and Tromsø 7, respectively.Primary and secondary outcomeThe presence of carotid plaques and plaque score assessed using ultrasound.ResultsThe presence of carotid plaques and plaque score were higher in KYH than Tromsø 7 regardless of age group and sex. A positive association between carotid plaque burden and adiposity was found (OR of having at least one plaque per SD in WHR 1.18 (95% CI 1.06 to 1.31) for men; 1.15 (1.06 to 1.25) for women)) adjusted for age, smoking and education in a pooled analysis of the two studies. There was little evidence of the interaction between study and adiposity. These effects did not differ between the two studies. However, neither adiposity nor CVD risk factors (smoking, systolic blood pressure, cholesterol, glycosylated haemoglobin) explained the higher carotid plaque burden in KYH compared with Tromsø 7.ConclusionAdiposity, especially abdominal adiposity, is a risk factor for carotid plaque in Russia and Norway, although neither adiposity nor established CVD risk factors explained the higher plaque burden in Russia. To reduce the CVD burden in Russia, beyond prevention and treatment of adiposity, further research is required to understand why Russia has a high burden of atherosclerosis.

Small Dense Low-Density Lipoprotein Cholesterol and Carotid Intimal Medial Thickness Progression.

Aim: The association between small dense low-density lipoprotein cholesterol (sdLDL-C) levels and carotid intimal medial thickness (cIMT) progression has not been evaluated fully. We assessed specialized lipoproteins, including sdLDL-C, with regard to cIMT progression in a prospective observational study in Japan.Methods: Plasma total cholesterol, direct LDL-C, sdLDL-C, LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, triglycerides, Lp(a), and adiponectin were measured in 2,030 men and women (median age 59 years, free of cardiovascular disease (CVD) and off cholesterol lowering medication). At both baseline and after a five-year follow-up, cIMT was assessed. Univariate, multivariate regression, and least square analyses were performed to examine the relationships between direct LDL-C, sdLDL-C, and other lipoproteins with cIMT progression.Results: The median cIMT at baseline was 0.63 mm and five-year progression was 0.18 mm. After adjustment for standard CVD risk factors, including age, gender, systolic blood pressure, total cholesterol, HDL-C, smoking, diabetes, and hypertension treatment, only direct LDL-C, sdLDL-C, and the sdLDL-C/LDL-C ratio were associated with cIMT progression. Even in subjects with direct LDL-C < 100 mg/dL, who were considered at low CVD risk, elevated sdLDL-C were associated with cIMT progression (P for trend = 0.009) in a model with established CVD risk factors, although the sdLDL-C/LDL-C ratio did not. Those correlations did not change by including triglycerides as a controlling factor or excluding premenopausal women from the analyzed population.Conclusions: Small dense LDL-C has a stronger relationship with cIMT progression than LDL-C does; therefore, measuring sdLDL-C may allow for the formulation of optimal therapy for CVD prevention.

GlycA: A New Biomarker for Systemic Inflammation and Cardiovascular Disease (CVD) Risk Assessment.

The GlycA test is a recently developed proton nuclear magnetic resonance (1H-NMR) spectroscopy-based assay that has been gaining increased interest as a serum biomarker for systemic inflammation, and consequently, as a potential biomarker for cardiovascular disease (CVD) risk assessment. The test has undergone investigation in several large cohort studies, since its development, to assess its predictive value for incident CVD events, CVD-associated mortality, and all-cause mortality. Despite variation in the generated estimates by these studies, they have all consistently demonstrated moderate-strength positive correlations between baseline GlycA levels, and incident CVD event rates and associated mortality. These correlations withheld testing even after adjusting for several other established CVD risk factors, including notable inflammatory biomarkers such as high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Compared with hsCRP, which is a well-known inflammatory biomarker for CVD risk assessment, GlycA has a comparable predictive value for future CVD-related events. However, the indications to pursue GlycA testing, and its clinical utility in patient care management, are yet to be determined. In this review, we define the GlycA test and what it "measures", and provide a brief summary of the findings of studies showing its association with incident CVD rates, and CVD-related mortality, as well as its correlation with other inflammatory biomarkers, namely hsCRP. Finally, we highlight the analytical advantages of the GlycA test, compared with "traditional" inflammatory biomarkers, while also mentioning its current limitations.

Age‐Related Increase in Extra‐Media Thickness is Associated with Arterial Stiffening and Carotid Blood Pressure

Older age is a primary risk factor associated with future cardiovascular disease (CVD) related events. Age‐related changes in perivascular adipose tissue (PVAT) and vascular remodeling both contribute to arterial stiffening and increased blood pressure which are established CVD risk factors. The non‐invasively measured extra‐media thickness (EMT) is a novel and composite measure, which includes PVAT, arterial adventitia, and the jugular vein that may provide translational insight for these factors contributing to age‐related arterial stiffening and higher blood pressure. However, it is unknown if aging increases EMT and is associated with arterial stiffness and blood pressure. We hypothesized that age‐related increases in EMT will be associated with higher arterial stiffness and blood pressure. Forty participants (young: 8M/12F, 23.2 ± 1.1 yrs and middle‐aged/older: 7M/13F, 60.7 ± 9.4 yrs) underwent measures of blood pressure (brachial; carotid), arterial stiffness (carotid b‐stiffness), EMT via ultrasonography and body composition with dual x‐ray absorptiometry. All measurements were taken in the supine position. Group mean differences between young and middle‐aged/older participants were analyzed with unpaired t‐tests and Pearson correlations were used to assess relations between EMT and arterial stiffness and blood pressure endpoints. Compared to younger participants, middle‐aged/older participants had higher EMT (0.80 ± 0.03 vs. 0.69 ± 0.02 mm), carotid beta stiffness (3.24 ± 0.08 vs. 2.60 ± 0.04), carotid SBP (116.5 ± 4.9 vs. 99.1 ± 2.3 mmHg), and carotid PP (44.6 ± 4.2 vs. 34.8 ± 1.5 mmHg) (all, p&lt;0.05). Brachial SBP was not different between groups (p&gt;0.05). Carotid beta stiffness (r= 0.410), carotid SBP (r= 0.501), and carotid PP (r= 0.5037) were all positively correlated with EMT for the entire cohort (all, p&lt;0.05). Our findings indicate that there is an age‐related increase in EMT that is associated with both carotid arterial stiffness and pressure. These data suggest that increases in arterial stiffness and blood pressure with advancing age may be attributable, in part, to increases in EMT, which may be due to changes in PVAT and arterial adventitial remodeling. Therefore, EMT, a potential surrogate for PVAT and arterial remodeling, may provide novel insight into age‐related arterial stiffening, higher blood pressure and increased CVD risk with aging.

Abstract 49: Consumption of Ultra-processed Foods and Beverages is Associated With Increased Risk of Cardiovascular Mortality in the Moli-sani Study Cohort

Introduction: Consumption of ultra-processed food and beverages (UPFB) is gaining growing attention due to its possible relation with increased risk of disease/mortality. To date, the possibility of such an association was only addressed in two European and one US population-based cohorts. Hypothesis: We assessed the hypothesis of a positive association between UPFB consumption and mortality risk in a large sample of the Italian population and tested whether some known cardiovascular disease (CVD) risk factors and nutrients could be on the pathway of this relation. We also separately analyzed UPFB presumed to be healthy ( e.g. , breakfast cereals, fruit juices) from nutrient-poor foods ( e.g., cakes, snacks). Methods: Longitudinal analysis on 22,810 men and women (mean age 55±12 y) recruited in the Moli-sani Study cohort between 2005-2010. Food intake was assessed using a semi-quantitative 188-item food frequency questionnaire. UPFB intake was defined by the NOVA classification according to degree of food processing and then categorized as number of servings/d. Hazard ratios with 95% confidence intervals (95% CI) were calculated using multivariable Cox-proportional hazard models. Results: Over a median follow up of 8.3 y, 1,235 deaths were ascertained. As opposed to lower intake (&lt;2 servings/d), individuals reporting high intake of UPFB (&gt;4 servings/d) experienced an increased risk of CVD mortality (HR=1.50; 95%CI 1.18-1.92) and of death for ischemic heart (IHD)/cerebrovascular disease (1.56; 1.13-2.14). An upward trend was found for all-cause mortality too (1.15; 1.00-1.34). Biomarkers of renal function (cystatin C and creatinine) or of lipid metabolisms were likely to be on the pathway between UPFB and CVD mortality. Among selected macronutrients, high content of sugar and saturated fats possibly drove the relation of UPFB with CVD mortality. High intake of ‘healthy’ UPFB was associated with an increased trend of risk comparable to that associated with ‘unhealthy’ UPFB. Conclusions: In a large Mediterranean cohort of Italian adults, high consumption of UPFB was associated with increased risk of CVD death and IHD/cerebrovascular mortality. This association was partly explained by established CVD risk factors and a high dietary content of sugar and saturated fats. UPFB presumed to be healthy appeared similarly linked to higher death risk. National dietary guidelines might consider discourage excessive consumption of ultra-processed food while recommending natural or minimally processed foods.

Abstract P493: Small Dense Low-density Lipoprotein Cholesterol and Carotid Intimal Medial Thickness Progression

Introduction: Carotid intimal medical thickness (cIMT) is associated with cardiovascular disease (CVD). The association between atherogenic lipoproteins including small dense low-density lipoprotein cholesterol (sdLDL-C) and carotid intimal medial thickness (cIMT) progression has not been fully evaluated in a prospective cohort study. Hypothesis: We assessed the hypothesis that sdLDL-C is the most atherogenic lipoproteins with regard to cIMT progression. Methods: Kyushu and Okinawa Population Study (KOPS) is a community-based, prospective, and observational study in Japan which has been underway since 2004 and a total of 18,762 participants have been enrolled. For this study, we included 2,030 male and female participants (median age 59 years at baseline) who were free of CVD and off cholesterol lowering medication, and had cIMT measured at both baseline and after 5 years follow-up survey. Using plasma samples obtained from those subjects after overnight fast, we measured total cholesterol, direct low-density lipoprotein cholesterol (LDL-C), sdLDL-C, LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, triglycerides, Lp(a), adiponectin and high sensitivity C reactive protein (hs CRP). Their cIMT levels were measured by B-mode ultrasonography with a 10 MHz probe at far walls of their both right and left common carotid arteries. Results: Median cIMT at baseline was 0.63 mm and median 5 year progression was 0.18 mm. After adjustment for standard CVD risk factor including age, gender, systolic blood pressure, total cholesterol, HDL-C, smoking, diabetes, and hypertension treatment, only LDL-C, sdLDL-C, and the sdLDL-C/LDL-C ratio were associated with cIMT progression. Even in subjects with direct LDL-C &lt; 100 mg/dL, considered to be at low CVD risk, elevated sdLDL-C were associated with cIMT progression ( P for trend = 0.009) in a model with established CVD risk factors, although the sdLDL-C/LDL-C ratio did not. Conclusions: In conclusion, both sdLDL-C and direct LDL-C are significantly associated with cIMT progression. Moreover sdLDL-C has stronger relationship with cIMT progression than does LDL-C; therefore, measurement of sdLDL-C may allow for the formulation of optimal therapy to cIMT progression.

Abstract MP74: Association of Albuminuria With Incident Atrial Fibrillation: The Multi-ethnic Study of Atherosclerosis (MESA)

Background: Atrial fibrillation (AF) shares risk factors with atherosclerotic cardiovascular disease (CVD). Albuminuria (AU) is an established risk factor for renal failure and CVD. Endothelial dysfunction, inflammation and hemostasis underlie the pathogenesis of AU. However, the association of AU with incident AF and its effect modifiers are not fully understood. Purpose: To assess the association of AU with incident AF and to identify its effect modifiers. Methods: We studied MESA participants, free of clinical CVD and AF at baseline, with urine samples at exam 1. Participants were followed for incident AF ascertained by follow up visit ECGs, hospital discharge diagnoses or Medicare claims data. Participants were compared by the presence or absence of AU (albumin-creatine ratio of ≥30). Kaplan-Meier curves were used to estimate the cumulative rate of incident AF and log-rank test to evaluate statistical significance. Hazard ratio (HR) and 95% confidence interval (CI) were computed by Cox proportional hazard models. Final adjusted model included CHARGE-AF risk score covariates with socioeconomic variables, current alcohol use, renal function, and lipid lowering medication use. Results: A total of 6376 participants were analyzed (median age 62 years, male 47.4%, White race 38.8%, mean BMI 28.3 ± 5.5). During median follow-up of 13.9 years, there were a total of 924 AF events. Participants with AU had a higher incidence of AF than those without AU at 10 years (23.9% vs 10.4%, p &lt; 0.05, Figure 1A ). In fully adjusted model, AU was significantly associated with incident AF [HR 1.53 (95% CI 1.27 - 1.85, p &lt; 0.01). Low high-density lipoprotein cholesterol (&lt; 40 mg/dL) and high triglyceride (≥ 150 mg/dL) augmented the association between AU and incident AF (p-interaction &lt; 0.05 for all, Figure 1B ). Conclusion: AU was significantly associated with incident AF after adjusting for conventional risk factors in a multi-racial prospective cohort. Lipid markers were identified as effect modifiers in the association of AU with AF.

CORONARY ARTERY CALCIUM PROGRESSION AND CVD RISK AMONG THOSE ON STATIN THERAPY

Progression of coronary artery calcification (CAC) predicts the risk of cardiovascular disease (CVD) and all-cause mortality beyond established CVD risk factors. However, some studies report statin use is associated with CAC progression. We evaluated whether CAC progression was as strongly

Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis.

Gestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57-2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02-0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08-0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.

Oral GLP1 Analog: Where Does the Tide Go?

T2D is a potentially preventable disease that has been ranked the seventh leading cause of mortality in the United States. There is strong evidence demonstrating that preventing type 2 diabetes is, in many cases, attainable through lifestyle intervention. Unfortunately, prediabetes is mostly overlooked and awareness with diabetes prevention tools is lacking among primary care physicians. Nationally, efforts were not successful in reversing this epidemic even with an array of diabetes medications. Among the most effective medications for T2D are glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have been shown to reduce both A1C and body weight. Dulaglutide, liraglutide and injectable semaglutide also reduced cardiovascular events and cardiovascular mortality in patients with established cardiovascular disease or multiple cardiovascular risk factors. In this review, we will examine the first FDA approved oral GLP-1 RA; semaglutide. Moreover, this review will discuss the potential impact oral semaglutide may have on glycemic control, weight loss and cardiovascular comorbidities. It also examines the factors that may impact patient compliance, including cost, side effects and clinical issues. Finally, it deliberates the optimism surrounding the development of oral semaglutide in the treatment of diabetes as well as related conditions, such as obesity and non-alcoholic fatty liver disease (NAFLD).

Global myocardial longitudinal strain in a general population-associations with blood pressure and subclinical heart failure: The Tromsø Study.

The early detection of subclinical myocardial dysfunction can contribute to the treatment and prevention of heart failure (HF). The aim of the study was to (i) describe myocardial global longitudinal strain (GLS) patterns in a large general population sample from Norway and their relation to established cardiovascular disease (CVD) risk factors; (ii) to determine its normal thresholds in healthy individuals and (iii) ascertain the relation of myocardial GLS to stage A subclinical heart failure (SAHF). Participants (n = 1855) of the 7th survey of the population-based Tromsø Study of Norway (2015-2016) with GLS measurements were studied. Linear and logistic regression models were used for assessment of the associations between CVD risk factors and GLS. Mean GLS (SD) in healthy participants was - 15.9 (2.7) % in men and - 17.8 (3.1)% in women. Among healthy subjects, defined as those without known cardiovascular diseases and comorbidities, GLS declined with age. An increase of systolic blood pressure (SBP) of 10mm Hg was associated with a 0.2% GLS reduction. Myocardial GLS in individuals with SAHF was 1.2% lower than in participants without SAHF (p < 0.001). Mean myocardial GLS declines with age in both sexes, both in a general population and in the healthy subsample. SBP increase associated with GLS decline in women. Our findings indicate high sensitivity of GLS for early subclinical stages of HF.

Do self-reported pregnancy complications add to risk evaluation in older women with established cardiovascular disease?

BackgroundIn postmenopausal women with established cardiovascular disease (CVD), it is unknown whether a history of pregnancy complications are related to multisite artery disease (MSAD), defined as atherosclerotic lesions in at least two major vascular beds. Pregnancy complications are an established risk factor for CVD. This study aimed to investigate the frequency of pregnancy complications and their association to specific atherosclerotic manifestations and prediction of MSAD in older women with and without CVD.MethodsIn total, 556 women were invited to participate in the study. Of these women 307 reported former pregnancy from a cohort of women with (n = 233) and without CVD (n = 74). The self-reported frequency of pregnancy complications were surveyed retrospectively by a questionnaire that included miscarriage, subfertility, gestational hypertension (GHT) and/or preeclampsia (PE), low birth weight, preterm birth, bleeding in late pregnancy, gestational diabetes mellitus and high birth weight. Three vascular beds were examined, the peripheral, carotid and coronary arteries.ResultsThe mean age was 67.5 (SD 9.5) years. GHT and/or PE tended to be more common, but not significant, in women with CVD than in women without (20.3% vs 10.8%, p = 0.066). Among women with GHT and/or PE, hypertension later in life were more frequent than in women without (66.7% vs 47.4%, p = 0.010). GHT and/or PE were not associated with specific atherosclerotic manifestations or prediction of MSAD.ConclusionsIn older women with established CVD, pregnancy complications was not associated to specific atherosclerotic manifestations and may not provide additional value to the risk evaluation for MSAD.

Sodium-Glucose Co-Transporter2 Inhibitors and Fracture Risk.

Patients with type 2 diabetes mellitus (T2DM) appear to have increased risk for fractures. In this context, the finding that canagliflozin, a sodium-glucose co-transporter-2 (SGLT) inhibitor, increased the risk for fracture compared with placebo in the Canagliflozin Cardiovascular Assessment Study (CANVAS), a large randomized controlled trial (RCT) in patients with established cardiovascular disease or multiple cardiovascular risk factors, created concern. In the present review, we summarize the data regarding the association between SGLT2 inhibitors and fracture risk in patients with T2DM. In contrast to the findings reported in CANVAS, canagliflozin did not affect the risk of fracture in a more recent, large RCT in patients with diabetic nephropathy. In addition, empagliflozin and dapagliflozin, other members of this class, also do not appear to affect the incidence of fracture. Moreover, there is no clear pathogenetic mechanism through which SGLT2 inhibitors increase the risk for fractures. Therefore, available data are inconclusive to attribute to these drugs a direct responsibility for bone fractures.

336. Disparities in Cardiovascular Disease Prevention Among Persons Living with HIV in the United States Military Natural History Study

BackgroundThe use of antiretroviral therapy has reduced morbidity and mortality associated with HIV infection primarily due to the reduction of AIDS-related events. Although guidelines have aimed to standardize preventive care, disparities in prevention of cardiovascular disease remain prevalent across multiple cohorts.MethodsThe US Military HIV Natural History Study is an open cohort of Department of Defense beneficiaries. We included subjects aged 21–75 whose most recent study visit was between October 2015 and September 2016 and conducted a retrospective cross-sectional analysis of established cardiovascular disease risk factors and statin use. To determine statin eligibility we used the American College of Cardiology/American Heart Association 2013 atherosclerotic cardiovascular disease management guidelines and included subjects who had all necessary data elements for analysis.ResultsThe participants (n = 1223) were predominantly middle-aged (median 47 years, Interquartile Range [IQR] 33–55), male (95%), and were racially diverse (46% African-American, 16% Hispanic/other). The rate of tobacco use was 16%, diabetes was 11%, and 36% had hypertension. In total, 486 (40%) patients met criteria for statin therapy, with 17% of those being for secondary prevention. As of their last visit, 52 (4%) had a detectable HIV viral load. Statins were prescribed to only 302 (62%) of those with an indication, with lower prescription rates in African Americans (52%) and Hispanics (58%) than Caucasians (73%). Average blood pressure, rates of tobacco use, and prevalence of diabetes were equal between the African American and Caucasian groups.ConclusionWe found significant racial disparities in both primary and secondary cardiovascular disease mitigation within the military healthcare system. Previous studies have found similar racial differences attributed to socioeconomic factors and higher rates of intravenous drug use. As active duty service members have a stable income, open access to healthcare, and low rates of injection drug use, our findings challenge that premise. Understanding whether this is due to prescribing practices, physician-patient relationships, or healthcare uptake is critical to narrowing this major gap in care. Disclosures All authors: No reported disclosures.