Excess Coronary Heart Disease Research Articles

Cost-Effectiveness of Population-Based Multigene Testing for Breast and Ovarian Cancer Prevention

The current method of BRCA testing for breast and ovarian cancer prevention, which is based on family history, often fails to identify many carriers of pathogenic variants. Population-based genetic testing offers a transformative approach in cancer prevention by allowing for proactive identification of any high-risk individuals and enabling early interventions. To assess the lifetime incremental effectiveness, costs, and cost-effectiveness of population-based multigene testing vs family history-based testing. This economic evaluation used a microsimulation model to assess the cost-effectiveness of multigene testing (BRCA1, BRCA2, and PALB2) for all women aged 30 to 35 years compared with the current standard of care that is family history based. Carriers of pathogenic variants were offered interventions, such as magnetic resonance imaging with or without mammography, chemoprevention, or risk-reducing mastectomy and salpingo-oophorectomy, to reduce cancer risk. A total of 2000 simulations were run on 1 000 000 women, using a lifetime time horizon and payer perspective, and costs were adjusted to 2022 US dollars. This study was conducted from September 1, 2020, to December 15, 2023. The main outcome measure was the incremental cost-effectiveness ratio (ICER), quantified as cost per quality-adjusted life-year (QALY) gained. Secondary outcomes included incremental cost, additional breast and ovarian cancer cases prevented, and excess deaths due to coronary heart disease (CHD). The study assessed 1 000 000 simulated women aged 30 to 35 years in the US. In the base case, population-based multigene testing was more cost-effective compared with family history-based testing, with an ICER of $55 548 per QALY (95% CI, $47 288-$65 850 per QALY). Population-based multigene testing would be able to prevent an additional 1338 cases of breast cancer and 663 cases of ovarian cancer, but it would also result in 69 cases of excess CHD and 10 excess CHD deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multigene testing is cost-effective was 100%. When the cost of the multigene test exceeded $825, population-based testing was no longer cost-effective (ICER, $100 005 per QALY; 95% CI, $87 601-$11 6323). In this economic analysis of population-based multigene testing, population-based testing was a more cost-effective strategy for the prevention of breast cancer and ovarian cancer when compared with the current family history-based testing strategy at the $100 000 per QALY willingness-to-pay threshold. These findings support the need for more comprehensive genetic testing strategies to identify pathogenic variant carriers and enable informed decision-making for personalized risk management.

Familial Hypercholesterolemia Variant and Cardiovascular Risk in Individuals With Elevated Cholesterol

Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified. To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (≥190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults. A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023. LDL-C, cumulative past LDL-C, FH variant status. Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults. Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3%) and in 33 individuals with severely elevated LDL-C (2.5%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95% CI, 1.4-6.0) and 2.6 (95% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant. In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.

Using socioeconomic disparities in ACS mortality to identify opportunities for better cardiac care

Abstract Background Though cardiac care in acute coronary syndrome (ACS) should be equitable, socioeconomic disparities in associated mortality persist. In this study we ask if problems in provision of cardiac care could be pinpointed by examining these disparities in mortality between different time-points of ACS care. Thus, we assessed how socioeconomic disparities in one-year coronary heart disease (CHD) mortality emerged in Finland both outside hospital and in three consecutive time-points after ACS hospitalisation. Methods We obtained individual data of incident ACS hospitalisation for those aged ≥40 in 2013-2017 from national hospitalisation registers. Respective data for CHD mortality, education, income, living alone and travel time to hospital were obtained from Statistics Finland and from Digiroad database. Comorbidity was measured with Charlson index. Two-level Poisson multilevel models provided incidence rate ratios (IRRs) separately in total CHD mortality (including prehospital deaths) and by the time of death after ACS hospitalisation (within 1-7 days, 8-28 d and 29-365 d). Variation between hospital districts was adjusted for with random effects. Results Of 31,902 CHD deaths 74.9% occurred prehospital, 9.0% within 1-7 d, 6.2% within 8-28 d and 9.9% within 29-365 d of ACS hospitalisation. IRRs for living alone were 1.25-fold (CI95% 1.22-1.29) for total CHD mortality but varied between 0.95-1.05-fold after ACS hospitalisation. A clear income gradient emerged favouring higher quintiles. In the highest quintile IRRs were constantly 0.53-0.56-fold (CI95% 0.43-0.73) to those of the lowest quintile. In other quintiles income disparities were fewer, especially within 1-7 d. Conclusions Though socioeconomic disparities in CHD mortality persisted throughout cardiac care, more focus should be given especially to subacute care and rehabilitation of vulnerable groups. Improving early identification of ACS in those living alone offers opportunities to decrease excess CHD mortality. Key messages • A detailed analysis of socioeconomic disparities in one-year mortality after acute coronary syndrome event can provide opportunities for improving provision of cardiac care. • More focus should be given especially to subacute cardiac care and rehabilitation of vulnerable populations, as well as to early identification of acute coronary syndrome events in those living alone.

Cost-effectiveness analyses of population-based multi-gene testing for the prevention of breast and ovarian cancer in the United States.

10596 Background: The current method of testing for BRCA gene mutations, which is based on family history, often fails to identify many carriers. With the advancement of next-generation sequencing technologies, which have significantly lowered the cost of genetic testing and sequencing, population-based testing has been proposed. We evaluated the cost-effectiveness of population-based multi-gene testing as a means of preventing breast and ovarian cancer. Methods: We developed a microsimulation model to assess the cost-effectiveness of multi-gene testing (BRCA1/BRCA2/PALB2) for all women aged 30-35 years compared to the current standard of care that is family history-based. We selected these genes for analyses as they are most prevalent high penetrance genes. We assumed a test uptake rate of 70%. Carriers of pathogenic variants who were not affected by cancer were offered interventions, such as MRI/mammography, chemoprevention, or risk-reducing mastectomy and risk-reducing salpingo-ophorectomy (RRSO), to reduce the risk of breast and ovarian cancer. We incorporated excess coronary heart disease (CHD) deaths from premenopausal RRSO. Our main outcome measure was the incremental cost-effectiveness ratio (ICER)(i.e., cost per-quality-adjusted life year (QALY) gained), with the commonly used societal willingness to pay of $100,000/QALY in the US as the C-E threshold. We ran 500 simulations on 1,000,000 women, employing a lifetime time horizon and payer perspective, and adjusted the cost to 2022 US dollar. We also used probabilistic sensitivity analyses to evaluate model uncertainty. Results: In the base case, population-based multi-gene testing is more cost-effective compared to family-history based testing, with an ICER of $41,306/QALY (95%CI $35,630-$48,441/QALY). This new testing method is able to prevent an additional 1,369 cases of breast cancer and 807 cases of ovarian cancer, but it will also result in 8 excess heart-disease deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multi-gene testing is cost-effective is 100% for all the simulations. When the cost of the test exceeds $1,100 population-based multi-gene testing becomes economically inefficient (ICER $10,0886/QALY). Conclusions: Population-based multi-gene testing is a more cost-effective option for the prevention of breast cancer and ovarian cancer when compared to current family-history-based testing methods.

Risk factor management: opportunity or necessity?

The article is devoted to topical issues of reducing mortality from cardiovascular diseases and the role of behavioral risk factors on the example of the Ryazan region. There is a high contribution of acute and chronic forms of coronary heart disease (IHD) to mortality from diseases of the circulatory system and, in general, to mortality from all causes. The main risk factors contributing to the development of stroke, myocardial infarction, percutaneous coronary interventions and all-cause mortality are dyslipidemias, high SCORE risk, high blood pressure, excessive alcohol consumption and coronary heart disease, stroke, a history of myocardial infarction, the need for exposure becomes obvious. on these factors and factors associated with a high risk of fatal and non-fatal events. Correction of risk factors is possible only through the implementation of integrated prevention programs. Preliminary results from the Healthy Heart 2021 project demonstrated the potential for improved control of risk factors at the population level and the need to continue the project at the regional level. In addition, it seems necessary to expand it with the formation of subprograms in the framework of reducing mortality from other chronic non-communicable diseases.

Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study.

This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors. EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%). In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.

Abstract 13075: Initial Physical Activity Level is a Strong Predictor of Adherence to the Physical Activity Goal: A Secondary Analysis of the SMARTER Weight Loss Trial

Background: Over a third of excess coronary heart disease mortality in the US is related to inadequate physical activity (PA). Use of wearable activity trackers is beneficial for PA improvement in many populations. However, predictors of long-term adherence to PA remain unknown. Hypothesis: The 1 st week PA levels will be the strongest predictors of long-term adherence to the PA goal in adults with overweight or obesity in a mHealth weight loss intervention trial. Methods: A secondary analysis of a 12-month behavioral weight loss trial (SMARTER) that randomized 502 participants to either self-monitoring with tailored feedback messages (SM+FB, n=251) or self-monitoring alone (SM, n=251) was conducted. At baseline, each participant received a Fitbit Charge 2 and PA goal of ≥150 minutes of moderate or vigorous activity (MVPA) per week. The outcome of interest for this analysis was long-term PA adherence, i.e., the number of weeks adherent to PA goal over 12 months. Twenty-six explanatory variables were considered, including treatment assignment; baseline socio-demographics; health history; body mass index (<30 vs. ≥30 kg/m 2 ); psychosocial factors; and1 st week PA levels (<150 vs. ≥150 MVPA min/week). Machine learning methods (i.e., random forest regression trees and lasso regression) were used to identify predictors of long-term PA adherence. Results: The sample ranged in age from 19 to 75 years (57% were <50 years old), and was mostly Caucasian (83%), female (80%) and had a mean BMI 33.7 ± 4.0 kg/m 2 . The sample was randomly split 4:1 into training (n=394) and validation subsamples (n=104) which were comparable by treatment assignment. Both random forest and lasso regression identified 1 st week PA levels as the most important predictor of long-term PA adherence. The findings were confirmed in the validation cohort with an out-of-sample R-square of 40.2% from random forest and a R-square of 47.9% from lasso regression, suggesting good predictive abilities. Conclusion: This analysis confirmed higher initial PA levels as the strongest predictor of long-term PA adherence. The findings support screening for PA at study entry and developing tailored interventions for those with lower initial PA levels.

Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults

Individuals with low socioeconomic status (SES) bear a disproportionate share of the coronary heart disease (CHD) burden, and CHD remains the leading cause of mortality in low-income US counties. To estimate the excess CHD burden among individuals in the United States with low SES and the proportions attributable to traditional risk factors and to other factors associated with low SES. This computer simulation study used the Cardiovascular Disease Policy Model, a model of CHD and stroke incidence, prevalence, and mortality among adults in the United States, to project the excess burden of early CHD. The proportion of this excess burden attributable to traditional CHD risk factors (smoking, high blood pressure, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, type 2 diabetes, and high body mass index) compared with the proportion attributable to other risk factors associated with low SES was estimated. Model inputs were derived from nationally representative US data and cohort studies of incident CHD. All US adults aged 35 to 64 years, stratified by SES, were included in the simulations. Low SES was defined as income below 150% of the federal poverty level or educational level less than a high school diploma. Premature (before age 65 years) myocardial infarction (MI) rates and CHD deaths. Approximately 31.2 million US adults aged 35 to 64 years had low SES, of whom approximately 16 million (51.3%) were women. Compared with individuals with higher SES, both men and women in the low-SES group had double the rate of MIs (men: 34.8 [95% uncertainty interval (UI), 31.0-38.8] vs 17.6 [95% UI, 16.0-18.6]; women: 15.1 [95% UI, 13.4-16.9] vs 6.8 [95% UI, 6.3-7.4]) and CHD deaths (men: 14.3 [95% UI, 13.0-15.7] vs 7.6 [95% UI, 7.3-7.9]; women: 5.6 [95% UI, 5.0-6.2] vs 2.5 [95% UI, 2.3-2.6]) per 10 000 person-years. A higher burden of traditional CHD risk factors in adults with low SES explained 40% of these excess events; the remaining 60% of these events were attributable to other factors associated with low SES. Among a simulated cohort of 1.3 million adults with low SES who were 35 years old in 2015, the model projected that 250 000 individuals (19%) will develop CHD by age 65 years, with 119 000 (48%) of these CHD cases occurring in excess of those expected for individuals with higher SES. This study suggested that, for approximately one-quarter of US adults aged 35 to 64 years, low SES was substantially associated with early CHD burden. Although biomedical interventions to modify traditional risk factors may decrease the disease burden, disparities by SES may remain without addressing SES itself.

Abstract P252: Passive Smoking in Childhood and Mortality From Coronary Heart Disease in Adulthood Among Japanese Men and Women: The Jacc Study

Background: Secondhand smoke exposure among adults is an established risk factor for cardiovascular disease, but little is known about the impact of passive smoking in childhood on risk of adverse cardiovascular outcome in adulthood. We examined whether childhood exposure to secondhand smoke is associated with mortality from coronary heart disease(CHD) in adulthood among Japanese men and women. Methods: We analyzed the data for 71,459 participants ( 31,027 men and 40,432 women) aged 40-79 years, with no history of CHD, stroke, or cancer at the baseline (1988-1990) and who completed a lifestyle questionnaire including the number of family members who smoked at home in childhood(0,1,2 and 3+ members) under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: The sex-specific proportions of current smokers were 49.0% for 0 member, 54.3% for 1 member, 56.8% for 2 members and 59.3% for 3+members among men, and the respective proportions among women were 3.3%, 5.2%, 7.2%, and 11.2%.During the median follow-up of 18.9 years, a total of 955 (589 men and 366 women) deaths from CHD were reported. There was a dose-response relationship between the number of smoking family members at home and CHD mortality at adulthood among the middle aged (40-59 years); the multivariable HRs, adjusting for age, sex, history of hypertension and diabetes, body mass index, smoking status, alcohol consumption, hours of exercise and walking, perceived mental stress, educational level and employment status, were 1.05 (95% CI: 0.74, 1.48) for 1 family member, 1.27(0.83, 1.94) for 2 family members and 2.34(1.17, 4.68) for 3+ family members compared with no family member(p for trend=0.04). Such an association was not observed for the older persons aged 60-79 years.The excess CHD mortality associated with 3+ family members among the middle-aged was more evident among never or ex-smokers than among current smokers: the respective multivariable HRs were 3.74(1.40, 10.01) and 1.90(0.72, 5.06). Conclusions: Passive smoking exposure in childhood was associated with increased risk of mortality from CHD in adulthood, primarily for the middle aged men and non-current smokers.

Compare and correlate the levels of lipoprotein (a) and high-sensitive C-reactive protein in coronary heart disease with control

Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.

Occupational Class and Risk of Cardiovascular Disease Incidence inJapan: Nationwide, Multicenter, Hospital-Based Case-Control Study.

BackgroundIn contemporary Western settings, higher occupational class is associated with lower risk for cardiovascular disease (CVD) incidence, including coronary heart disease (CHD) and stroke. However, in non‐Western settings (including Japan), the occupational class gradient for cardiovascular disease risk has not been characterized.Methods and ResultsUsing a nationwide, multicenter hospital inpatient data set (1984–2016) in Japan, we conducted a matched hospital case‐control study with ≈1.1 million study subjects. Based on a standard national classification, we coded patients according to their longest‐held occupational class (blue‐collar, service, professional, manager) within each industrial sector (blue‐collar, service, white‐collar). Using blue‐collar workers in blue‐collar industries as the referent group, odds ratios and 95% CIs were estimated by conditional logistic regression with multiple imputation, matched for sex, age, admission date, and admitting hospital. Smoking and drinking were additionally controlled. Higher occupational class (professionals and managers) was associated with excess risk for CHD. Even after controlling for smoking and drinking, the excess odds across all industries remained significantly associated with CHD, being most pronounced among managers employed in service industries (odds ratio, 1.19; 95% CI, 1.08–1.31). On the other hand, the excess CHD risk in higher occupational class was offset by their lower risk for stroke (eg, odds ratio for professionals in blue‐collar industries, 0.77; 95% CI, 0.70–0.85).ConclusionsThe occupational “gradient” in cardiovascular disease (with lower risk observed in higher status occupations) may not be a universal phenomenon. In contemporary Japanese society, managers and professionals may experience higher risk for CHD.

Coronary Artery Calcium in Early Midlife Is Associated with Excess Coronary Heart Disease Risk

Coronary artery calcium (CAC) is a strong predictor of adverse coronary heart disease (CHD) events in older adults. In this study, researchers

Abstract P209: Dose-Response Relationship Between Dietary Intake of Alpha-linolenic Acid and Risk of Coronary Heart Disease: A Meta-analysis of Prospective Studies

Introduction: Previous studies show that alpha-linolenic acid (ALA) is associated with reduced risk of coronary heart disease (CHD). However, it remains unclear whether and how dietary ALA doses are related to CHD. Hypothesis: We hypothesized that higher dietary ALA intake is associated with a greater reduction in risk of CHD. Methods: We searched PubMed, EMBASE, and Web of Science for prospective studies examining the association between dietary ALA intake and CHD risk. Dietary ALA intake was assigned or measured by self-report. Outcomes were reported as total and fatal CHD and/or myocardial infarction, which were obtained from blinded endpoint assessments or medical records. Two-stage fixed-effects dose-response meta-analyses were conducted to estimate the association between increasing ALA intake (relative to study-specific referents) and CHD. Results: Fifteen published articles were identified and included in the meta-analysis (13 cohort studies and 2 randomized controlled trials). The pooled analysis was based on 310,768 individuals with 12,049 events with a mean length of follow-up of 9.6 years. The analysis showed a J-shaped curve between ALA intake and relative risk of total CHD (Chi-square=21.08, p<0.001). ALA intake from 0.3-1.4g/day showed reduced risk of total CHD, while intake ≥2.5g/day was associated with increased risk of CHD, compared to people without ALA intake (Figure 1A). Approximately 1g/day of ALA intake was associated with the lowest risk of total CHD. ALA intake was linearly associated with fatal CHD - every 1g/day increase in ALA intake was associated with an 11% decrease in fatal CHD risk (95% CI: -0.16, -0.05) (Figure 1B). Conclusion: The J-shaped dose-response relationship based on our pooled analysis suggests that 1g/day of dietary ALA may be optimal for total CHD prevention. Though a higher dietary ALA intake was associated with reduced risk of fatal CHD, the excess total CHD risk at higher ALA intakes warrants further investigation, especially through randomized controlled trials.

Job strain and the incidence of coronary heart diseases: does the association differ among occupational classes? A contribution from a pooled analysis of Northern Italian cohorts

ObjectivesTo assess the association between job strain (JS) and the incidence of coronary heart disease (CHD) in North Italian employed men, adopting a stratified analysis by occupational class (OC).MethodsThe study...

Elevated Circulating Osteoprotegerin and Renal Dysfunction Predict 15-Year Cardiovascular and All-Cause Mortality: A Prospective Study of Elderly Women.

BackgroundData on the predictive role of estimated glomerular filtration rate (eGFR) and osteoprotegerin (OPG) for cardiovascular (CVD) and all-cause mortality risk have been presented by our group and others. We now present data on the interactions between OPG with stage I to III chronic kidney disease (CKD) for all-cause and CVD mortality.Methods and ResultsThe setting was a 15-year study of 1,292 women over 70 years of age initially randomized to a 5-year controlled trial of 1.2 g of calcium daily. Serum OPG and creatinine levels with complete mortality records obtained from the Western Australian Data Linkage System were available. Interactions were detected between OPG levels and eGFR for both CVD and all-cause mortality (P < 0.05). Compared to participants with eGFR ≥60ml/min/1.73m2 and low OPG, participants with eGFR of <60ml/min/1.73m2 and elevated OPG had a 61% and 75% increased risk of all-cause and CVD mortality respectively (multivariate-adjusted HR, 1.61; 95% CI, 1.27-2.05; P < 0.001 and HR, 1.75; 95% CI, 1.22-2.55; P = 0.003). This relationship with mortality was independent of decline in renal function (P<0.05). Specific causes of death in individuals with elevated OPG and stage III CKD highlighted an excess of coronary heart disease, renal failure and chronic obstructive pulmonary disease deaths (P < 0.05).ConclusionThe association between elevated OPG levels with CVD and all-cause mortality was more evident in elderly women with poorer renal function. Assessment of OPG in the context of renal function may be important in studies investigating its relationship with all-cause and CVD mortality.

Age- and Gender-Related Differences in LDL-Cholesterol Management in Outpatients with Type 2 Diabetes Mellitus.

Background. Dyslipidemia contribute to the excess of coronary heart disease (CHD) risk observed in women with type 2 diabetes (T2DM). Low density lipoprotein-cholesterol (LDL-C) is the major target for CHD prevention, and T2DM women seem to reach LDL-C targets less frequently than men. Aim. To explore age- and gender-related differences in LDL-C management in a large sample of outpatients with T2DM. Results. Overall, 415.294 patients (45.3% women) from 236 diabetes centers in Italy were included. Women were older and more obese, with longer diabetes duration, higher total-cholesterol, LDL-C, and HDL-C serum levels compared to men (P < 0.0001). Lipid profile was monitored in ~75% of subjects, women being monitored less frequently than men, irrespective of age. More women did not reach the LDL-C target as compared to men, particularly in the subgroup treated with lipid-lowering medications. The between-genders gap in reaching LDL-C targets increased with age and diabetes duration, favouring men in all groups. Conclusions. LDL-C management is worst in women with T2DM, who are monitored and reach targets less frequently than T2DM men. Similarly to men, they do not receive medications despite high LDL-C. These gender discrepancies increase with age and diabetes duration, exposing older women to higher CHD risk.

Thigh fat and muscle each contribute to excess cardiometabolic risk in South Asians, independent of visceral adipose tissue.

ObjectiveTo compare fat distribution and associations between fat depots and cardiometabolic traits in South Asians and Europeans.MethodsFive hundred and fourteen South Asians and 669 Europeans, aged 56-86. Questionnaires, record review, blood testing, and coronary artery calcification scores provided diabetes and clinical plus subclinical coronary heart disease (CHD) diagnoses. Abdominal visceral (VAT) and subcutaneous adipose tissue, thigh subcutaneous adipose tissue (TSAT), intermuscular and intramuscular thigh fat and thigh muscle were measured by CT.ResultsAccounting for body size, South Asians had greater VAT and TSAT than Europeans, but less thigh muscle. Associations between depots and disease were stronger in South Asians than Europeans. In multivariable analyses in South Asians, VAT was positively associated with diabetes and CHD, while TSAT and thigh muscle were protective for diabetes, and thigh muscle for CHD. Differences in VAT and thigh muscle only partially explained the excess diabetes and CHD in South Asians versus Europeans. Insulin resistance did not account for the effects of TSAT or thigh muscle.ConclusionsGreater VAT and TSAT and lesser thigh muscle in South Asians contributed to ethnic differences in cardiometabolic disease. Effects of TSAT and thigh muscle were independent of insulin resistance.

Increased cancer mortality in diabetic people treated with insulin: a register-based follow-up study

BackgroundThe national 10-year Development Programme for the Prevention and Care of Diabetes (DEHKO) was launched in Finland in 2000. The program focused on improving early diagnosis of type 2 diabetes and preventing diabetes-related complications. The FinDM database was established for epidemiological monitoring of diabetes and its complications. This study monitors mortality trends among people with diabetes during the DEHKO programme.MethodsA database obtained from a compilation of several administrative national health registers was used to study mortality in people with diabetes in 1998–2007. Relative excess mortality between people with and without diabetes was analyzed using Poisson regression models.ResultsThe number of diabetic people in Finland increased by 66% from 1997 reaching 284 832 in 2007. Like among non-diabetic people, all-cause mortality decreased in people with diabetes. Overall excess mortality remained high in people with diabetes; in 2003–2007 RRs in the non-insulin treated was 1.82 for men and 1.95 for women and in the insulin treated 3.45 and 4.29, and excess coronary heart disease mortality in the insulin treated: RR was 4.71 in men and 7.80 in women. A striking result was mortality from neoplasms; an increase in mortality emerged in almost every age group of insulin treated women.ConclusionCompared to non-diabetic people our monitoring showed declining excess mortality in non-insulin treated diabetic people mainly due to a decrease in mortality from cardiovascular diseases. For insulin treated, relative overall excess mortality remained unchanged and mortality from neoplasms increased among women.

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

BackgroundDespite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them.MethodsThe IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses.ResultsBetween 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD.ConclusionMost of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

QUALITY CHANGES OF DONUTS AS INFLUENCED BY LEAVENING AGENT AND HYDROCOLLOID COATINGS

ABSTRACT The effect of two edible coatings, methylcellulose (MC) and gum tragacanth (GT) in combination with two kinds of leavening agents, yeast and baking powder were examined on quality properties of donuts. Dough surface were coated with hydrocolloid solutions (1% w/w) then fried at 150C. GT and MC coatings significantly (P 0.05) effect on moisture content of fried donuts. Crust color increased with frying time and density decreased during first minuets of frying time. Results of sensory evaluation showed there was no significant difference between coated and uncoated donuts. However, yeast-raised samples significantly (P < 0.05) had highest score on the appearance, porosity and uniformity of pores in comparison with cake donuts. PRACTICAL APPLICATIONS Donuts are typically sweet delectable snacks that represent the largest breakfast category in the in-store bakery because it is portable and easy-to-eat. However, the fat content of fried products may reach up to 50% of its total weight, and nowadays, more and more challenges about oil consumption and relevant diet problems can be seen, like excess weight and coronary heart disease. So it leads to increase research corresponding to produce fried food with lower oil content with the same quality. This article provides new information about oil reduction of fried donut and its quality properties.