Family History Of Cardiovascular Disease Research Articles

Abstract EP60: Modification Effects Of Migraine Status And Stress Level On The Relationship Between Sleep Disturbance And 10-year Cardiovascular Disease Risk In Hong Kong Women

Background: Evidence has shown that worse sleep disturbance, frequent migraine attacks, and higher stress level predicted the higher cardiovascular diseases (CVDs) risk. Also, the significant associations between migraine, stress, and sleep quality have been identified in many previous studies. The purpose of this study was to explore the modification effects of migraine status and stress level on the relationship between sleep disturbance and 10-year CVDs risk in a sample of Hong Kong Chinese women. Method: Data were analyzed from the Hong Kong Women's Health Study 2019, a cross-sectional survey conducted in Hong Kong female nurses aged 30 years and above between 2019 and 2020. Mailed questionnaires were used for data collection. Sleep quality and stress level were measured by the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), respectively. The ID Migraine™ screening and doctor-diagnosed migraine that reported by the nurses were used together to identify the migraineurs. The 10-year CVDs risk was calculated by the Framingham 10-year risk score (FRS). The modification effect was tested by the stratified analysis and multiple linear regression model. Result: In total, 1,344 nurses with a mean age of 46.12 (SD=10.47) were involved in the study. Twenty-one percent of them had migraine and 29.6% had moderate or high level of stress (PSS score > 28). Among 704 (52.4%) participants who had poor sleep quality (Global PSQI score > 5), 96.9% of them had sleep disturbance. The mean score of FRS was 3.6% (3.3%), and 5.1% of the participants had a high level of CVDs risk (FRS≥10%). After adjusting of educational level, employment status, daily fruit and vegetable consumption, postmenopausal status and family history of CVDs, the sleep disturbance score was significantly associated with FRS [β=0.005; 95% confidence interval (CI): 0.003-0.010]. The stronger sleep disturbance-FRS association was observed among migraineurs (β=0.009; 95% CI: 0.004-0.013) and those with moderate or high level of stress (β=0.008; 95% CI: 0.004-0.013). Conclusion: Migraine status and stress level modified the strength of association between sleep disturbance and 10-year CVDs risk. Among nurses who had sleep disturbance, migraine and high level of stress aggravated the 10-year CVDs risk.

Clinical profiles of patients with myocardial infarction without obstructive coronary artery disease in Iran

Introduction: Myocardial infarction without obstructive coronary artery disease (MINOCA) accounts for 5-15% of acute myocardial infarction (MI) cases. Objectives: The purpose of this study is to determine the prevalence of diabetes, hypertension, hyperlipidemia, smoking, and family history of cardiovascular diseases (CVDs) and their association with gender in patients with MINOCA. Patients and Methods: Around 1772 patients entered this cross-sectional study. Prevalence of diabetes, hypertension and hyperlipidemia was significantly higher in women compared to men (P<0.001). Smoking was more common in men than women (P<0.001). Results: Women with MINOCA are more likely to have hypertension, hyperlipidemia and diabetes than men with MINOCA, whereas men are more likely to be smokers. Conclusion: Effective blood pressure control, correction of lipid profile and proper glycemic control can prevent MINOCA and its associated morbidities and mortality, especially in women.

Status of Cardiovascular Health in Chinese Children and Adolescents

The American Heart Association defined "ideal cardiovascular health (CVH)" in pediatric populations to promote primordial prevention in cardiovascular diseases. Little is known about CVH and associated sociodemographic factors among Chinese children and adolescents. This study aimed to evaluate CVH and the associations with sociodemographic characteristics in Chinese children and adolescents. This cross-sectional study analyzed baseline data of 15,583 participants aged 7 to 17 years from a Chinese national intervention program against obesity (2013-2014). CVH status was estimated according to 4 health behaviors (nonsmoking, body mass index, physical activity, and diet) and 3 health factors (total cholesterol, blood pressure, and fasting plasma glucose), using revised American Heart Association criteria. Multinomial logistic regression was used to assess the association between sociodemographic characteristics and the number of ideal CVH metrics. The prevalence of ideal CVH status was 1.7% (males: 1.9%; females: 1.6%) in the study population. The prevalence of ideal CVH behaviors and ideal health factors was 3.1% (males 3.3%; females: 3.0%) and 53.6% (males: 52.4%; females: 54.9%), respectively. Ideal fasting plasma glucose was the most prevalent component (males: 94.4%; females: 97.4%), whereas ideal physical activity (males: 34.6%; females: 23.9%) and diet (males: 28.3%; females: 30.1%) were the least prevalent. Female sex, younger age, undeveloped economy, residence in the southern region, and no family history of cardiovascular diseases were associated with more ideal CVH metrics. Ideal CVH status in Chinese children and adolescents is alarmingly rare. Physical activity and diet arekeytopromotion of CVH. Effective interventions are needed to promote CVH and reduce health disparities in early life.

Association of diuretic use with increased risk for long-term post-transplantation diabetes mellitus in kidney transplant recipients.

ABSTRACTBackgroundPost-transplantation diabetes mellitus (PTDM) is a major clinical problem in kidney transplant recipients (KTRs). Diuretic-induced hyperglycaemia and diabetes have been described in the general population. We aimed to investigate whether diuretics also increase PTDM risk in KTRs.MethodsWe included 486 stable outpatient KTRs (with a functioning graft ≥1 year) without diabetes from a prospective cohort study. Participants were classified as diuretic users and non-users based on their medication use verified by medical records.ResultsAt the baseline study, 168 (35%) KTRs used a diuretic (thiazide, n = 74; loop diuretic, n = 76; others, n = 18) and 318 KTRs did not use a diuretic. After 5.2 years [interquartile range (IQR) 4.0‒5.9] of follow up, 54 (11%) KTRs developed PTDM. In Cox regression analyses, diuretic use was associated with incident PTDM, independent of age, sex, fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) {hazard ratio [HR] 3.28 [95% confidence interval (CI) 1.84–5.83]; P <0.001}. Further adjustment for potential confounders, including lifestyle, family history of cardiovascular disease, use of other medication, kidney function, transplantation-specific parameters, BMI, lipids and blood pressure did not materially change the association. Moreover, in Cox regression analyses, both thiazide and loop diuretics associated with the development of PTDM, independent of age, sex, FPG and HbA1c [HR 2.70 (95% CI 1.24–5.29); P = 0.012 and HR 5.08 (95% CI 2.49–10.34); P <0.001), respectively].ConclusionsThis study demonstrates that diuretics overall are associated with an increased risk of developing PTDM in KTRs, independent of established risk factors for PTDM development. The association was present for both thiazide and loop diuretics.

A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease

BackgroundCardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease.MethodsThirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic.ResultsThe participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure.ConclusionsThe findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability.

The Joint Public Health Impact of Family History of Diabetes and Cardiovascular Disease among Adults in the United States: A Population-Based Study

Introduction: Family history is an established risk factor for both cardiovascular disease (CVD) and diabetes; however, no study has presented population-based prevalence estimates of family histories of CVD and diabetes and examined their joint impact on prevalence of diabetes, CVD, cardiometabolic risk factors, and mortality risk. Methods: We analyzed data from a representative sample of the US adult population including 29,440 participants from the National Health and Nutrition Examination Survey (2007–2018) and assessed self-reported first-degree family history of diabetes and CVD (premature heart disease before age of 50 years) as well as meeting criteria and/or having risk factors for CVD and diabetes. Results: Participants with joint family history exhibit 6.5 greater odds for having both diseases and are diagnosed with diabetes 6.6 years earlier than participants without family history. Healthy participants without prevalent CVD or diabetes but with joint family history exhibit a greater prevalence of diabetes risk factors compared to no family history counterparts. Joint family history is associated with an increase in all-cause mortality, but with no interactive effect. Conclusion: Over 44% of the US adult population has a family history of CVD and/or diabetes that is comparable in risk to common cardiometabolic risk factors. This wide presence of high-risk family history and its simplicity of ascertainment suggests that clinical and public health efforts should collect and act on joint family history of CVD and diabetes to improve population efforts in the prevention and early detection of these common chronic diseases.

Distribution and determinants of coronary artery calcium score in asymptomatic patients with diabetes in two different settings: Comparison between patients in continental France and La Reunion Island

Coronary artery calcium score (CACS) is increasingly used to refine the cardiovascular risk prediction in patients with diabetes worldwide. However, its distribution and determinants in this population remain controversial. We aimed to determine the CACS distribution and determinants in asymptomatic patients with diabetes and to compare them between Limoges and La Reunion and between sex groups. We used the medical records of patients with diabetes who had at least one CACS measurement between 2014 and 2020 in Limoges and La Reunion. CACS was classified into four categories (0: no plaque, 1–99: mild plaque, 100–399: moderate plaque, and ≥ 400: severe plaque). Multinomial logistic regression models were performed to determine the risk factors associated with each CACS categories. In addition, a risk score for having a CACS≥ 400 was created with the patients in Limoges and then tested on those in La Reunion. A total of 577 patients were analyzed (369 from Limoges and 208 from La Reunion). The highest proportion of high CACS was found in Limoges. The multivariate analysis showed that age (OR by 10 years = 3.82[2.45-5.97]), male sex (3.81[1.79-8.09]), diabetic retinopathy (3.45[1.29-9.20]), family history of cardiovascular diseases (3.23[1.44-7.25]) and statine use (3.71[1.25-11.0]) were independent risk factors for CACS≥ 400. The stratified analysis on sex and location showed that male patients had more risk factors for high CACS than female and that in both of the cities the factors associated with high CACS were approximately the same. Similarly, the performance of the created risk score assessed by the receiver operating characteristic curve showed approximately equal areas under the curve (AUC) between Limoges (AUC = 0.74) and La Reunion (AUC = 0.71). In this study, we found that regardless of location, patients with diabetes share the same risk factors for high CACS and that men have more risk factors than women.

A Debilitating Adverse Reaction of Pityriasis Rubra Pilaris Due to Statin Therapy in A Low-Risk Patient: Case Report

A 57-year-old male cardiologist with no previous cardiac history nor a positive family history of cardiovascular disease was started on atorvastatin to treat an LDL of 140 mg/dL. Within one month he developed a debilitating dermatologic reaction that initially was thought to be life-threatening Stevens-Johnson Syndrome. Biopsy demonstrated the reaction was Pityriasis Rubra Pilaris (PRP) an incurable dermatologic disease which on average lasts more than a year before resolution. As of the writing of this case report, 6 months after starting atorvastatin, the symptoms persist. This is only the second reported case of PRP resulting from statin therapy.

Cardiovascular disease (CVD) and its associated risk factors among older adults in India: Evidence from LASI Wave 1

BackgroundWith the turn of the century, CVDs have become the leading cause of mortality in India. Despite the wide heterogeneous prevalence of risk factors across different regions, CVD is the major cause of death in all parts of India. Therefore, the study aimed to investigate the prevalence of CVDs and its associated risk factors among older adults in India. MethodsThe current study used data from the LASI, Wave 1, the world's largest and India's first longitudinal aging study. The total sample for the analysis was 65562 (45 and above individuals). The self-reported prevalence of CVDs was calculated by considering any one of the self-reported diagnosed conditions of hypertension, stroke, and chronic heart diseases. Binary Logistic regression was carried out between CVD and its associated risk factors like age, sex, place of residence, physical activity, family history of CVD, Diabetes/blood sugar, high cholesterol. P < 0.05 from two-sided statistical tests was regarded statistically significant. ResultsThe study indicated that the overall self-reported prevalence of diagnosed CVDs was 29.4% for older adults age 45 and above in India. Age was associated with increased risk of CVD Female older adults were more likely to have CVDs than male.The place of residence also had a stronger association with CVDs.In addition, high cholesterol, diabetes and physical inactivity were key risk factors for CVDs.The study also indicated that Family history was associated with a greater perceived risk for CVDs. The greater prevalence of CVDs risk factors among older adults manifested alarming public health concerns and a future health demand. It creates a threat if health promotion and awareness programs are not well designed.

Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries

Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events.

Predictors of non-participation in a cardiac telerehabilitation programme: a prospective analysis.

Current cardiac telerehabilitation (CTR) interventions are insufficiently tailored to the preferences and competences of individual patients, which raises the question whether their implementation will increase overall participation and adherence to cardiac rehabilitation (CR). However, research on patient-specific factors that influence participation and adoption of CTR interventions is scarce. The aim of this study was to evaluate which patient-related characteristics influence participation in a novel CTR intervention in patients with coronary artery disease. This prospective observational substudy of the SmartCare-CAD randomized controlled trial evaluated patient characteristics of study participants as proxy for participation in a CTR intervention. We compared demographic, geographic, and health-related characteristics between trial participants and non-participants to determine which characteristics influenced trial participation. A total of 699 patients (300 participants and 399 non-participants; 84% male, mean age 64.3 ± 10.5 years) were included. Most of the non-participants refused participation because of insufficient technical skills or lack of interest in digital health (26%), or preferred centre-based CR (21%). Variables independently associated with non-participation included: higher age, lower educational level, shorter travelling distance, smoking, positive family history for cardiovascular disease, having undergone coronary artery bypass grafting; and a higher blood pressure, worse exercise capacity, and higher risk of depression before the start of CR. Participation in CTR is strongly influenced by demographic and health-related factors such as age, educational level, smoking status, and both physical and mental functioning. Cardiac telerehabilitation interventions should therefore be redesigned with the involvement of these currently underrepresented patient subgroups.

807 Wellens syndrome: a rare entity not to underestimate

Abstract Aims Abrupt oppressive chest pain is a common reason of emergency department’s access. An accurate assessment of the clinical setting is needed to ensure the patient the correct management. This includes a good anamnesis, physical examination, electrocardiogram (ECG) and cardiac biomarkers evaluation. Wellens syndrome is a clinical entity characterized by acute chest pain, normal or minimal elevation of cardiac biomarker, specific ECG changes with no ST elevation or Q-waves. The ECG modifications contemplate: biphasic T waves in lead V2 and V3 (type A) initially positive and subsequent negative or deep and symmetrically inverted T waves in anterior leads (Type B, more often V1–V4). Recognizing these patterns can be so challenging for physician in emergency departments, especially in Type A, and failure in diagnosis can lead to deleterious outcomes. In fact, Wellens syndrome can be considered as a pre-infarction state that needs immediate intervention: if not treated appropriately, about 75% of patients can suffer anterior myocardial infarction due to a stenosis of left anterior descending (LAD) artery. Methods A 55-year-old male with hyperlipidaemia and a family history of cardiovascular disease, presented to emergency department with abrupt oppressive chest pain after mild physical effort. At presentation he presented a typical ECG of Wellens syndrome type A with negative cardiac biomarkers. His GRACE (Global Registry of Acute Coronary Events) score was 72 and his thrombolysis in myocardial infarction (TIMI) was 2. At second blood sample cardiac biomarkers was mildly higher than upper limit of normal. Results Despite low grade on risk stratification he immediately underwent coronary angiography, who resulted in a subocclusive stenosis from ostium to the medium tract of LAD. PCI was subsequently taken with implantation of TWO drug eluting stent (DES). After 3 days he was discharged asymptomatic and in optical medical therapy. Conclusions Wellens syndrome is a rare clinical entity that must be considered as a pre- infarction state difficult to individuate. Conventional management in these patients utilizing typical risk stratification scores may not be appropriate. In this context an early diagnosis of ECG patterns it’s crucial, in order to provide an urgent percutaneous intervention. Failure in recognition of signs and symptoms of Wellens syndrome can lead to disastrous outcome due to a critical, vulnerable, stenosis on proxymal LAD and to a possible imminent large anterior myocardial infarction.

345 Blood pressure and autonomic function in essential hypertension: comparative evaluation of 24-hour heart rate variability and blood pressure

Abstract Aims Arterial hypertension (AHT) represents the leading cause of cardiovascular disease (CVD) and premature death worldwide. Essential AHT accounts for 95% of all cases of hypertension; although the aetiology of essential AHT is still largely unknown, a pivotal role of autonomic nervous system has been proposed and demonstrated. Both excessive sympathetic tone and vagal withdrawal, that define autonomic dysfunction, has been associated with essential AHT. The aim of our study was to investigate the relationship between blood pressure and autonomic function in essential hypertension; this was done comparing 24 h heart rate variability and 24 h blood pressure data, simultaneously collected, in a population of essential AHT subjects. Methods A prospective registry of 179 consecutive not selected essential AHT patients were considered in the present study. All patients underwent cardiac evaluation at the Primary and Secondary Cardiovascular Prevention Unit of the Don Gnocchi Foundation of Parma. All subjects underwent 24 h ECG monitoring, and 24 h Ambulatory Blood Pressure Monitoring, during the same day. Twenty-four hours Heart Rate variability analysis included: Time-domain, frequency-domain and non-linear domain. Results Mean age was 60 0a11.7 years, male gender was prevalent (68.4%). Among the population 26 (14.7%) subjects had diabetes; the prevalence of family history of CVD was 61.7% and 66.5% had dyslipidaemia; body mass index mean values were 27.6 7.4.3. In the whole population, the prevalence of uncontrolled AHT was 80.5%, divided into: 53.1% systo-diastolic, 17.9% isolated systolic, and 9.5% isolated diastolic. The prevalence of untreated AHT (recent diagnosis) was 40.2%, while treated AHT was 59.8% and only 19.6% had controlled blood pressure values (AHT at target). 12.3% of patients were treated with Beta Blockers. A significant correlations between diastolic blood pressure (DBP) values (24 h and day-time), LF/HF ratio (24 h) (r = 0.200; P = 007) and DFA alfa1 (24 h) (r = 0.325; P = 0.000), two know markers of sympathetic tone, were found. A higher sympathetic tone, expressed as high LF/HF, was found in isolated diastolic AHT compared to other types of AHT and the lowest sympathetic tone was found in isolated systolic AHT. Considering non-linear (complexity) analysis, DFA alfa1 (24 h) showed a significant correlation with DBP values that remained independent even after multiple adjustment for BMI, age, gender and Beta Blockers (β = 0.218; P = 0.011). Moreover, the lack of DBP control was associated with high sympathetic tone (LF/HF 3.8 112.3 vs 5.5 .33.3; P &amp;lt; 0.0001). On the other hand, no significant correlations between all DBP data and vagal markers, such as SDNN index, RMSSD and HF, were found. Again, no significant correlations between 24 h, daytime, night-time SBP and time or frequency HRV data as well as with non-linear (complexity) analysis were found. Finally, considering ‘autonomic dipping’, expressed as changes in HRV data between day and night, a strong inverse correlation between vagal markers and Heart Rate Dipping (r = −0.297; P &amp;lt; 0.0001) was found; correlation that remain independent even adjusted for age, gender, BMI, and BB. On the other hand, no association between blood pressure dipping and autonomic dipping was found. Conclusion Diastolic blood pressure and uncontrolled diastolic AHT, rather than systolic AHT, are associated with a hyper-sympathetic tone rather than with blunted vagal tone. The lack of heart rate dipping during night-time in AHT is associated with blunted vagal activation rather than a persistent night-time hyper-adrenergic tone.

Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term.

Background: Previous studies indicated preterm birth to be a risk factor for hypertension in adolescence and adulthood. However, studies in children investigating the underlying mechanisms are scarce.Objective: We hypothesized children born preterm to have higher excretion of cortisol and/or androgen metabolites per day concomitantly with higher blood pressure as compared to peers born at term. We thus aimed to compare urinary steroid profiles and blood pressure between 5- to 7-year-old children born preterm and peers born at term. Furthermore, aldosterone precursor excretion per day was compared between both groups.Methods: Blood pressure was measured in 236 children (preterms n = 116; gestational age 29.8 ± 2.6 (30; 24–33) weeks [mean ± standard deviation (median; range)]) using an automatic oscillometric device. Urinary steroid profiles were determined in 24-h urine samples (preterms n = 109; terms n = 113) using gas chromatographic-mass spectrometric analysis. To assess excretion of cortisol and androgen metabolites per day, major cortisol and androgen metabolites were summed, respectively. To assess aldosterone excretion per day tetrahydrocorticosterone, 5α-tetrahydrocorticosterone, and tetrahydro-11-deydrocorticosterone were summed.Results: Multiple regression analyses showed prematurity to be associated with systolic but not with diastolic blood pressure. When adjusted for potential confounders (prematurity, gender, age at day of examination, being born small for gestational age, breastfeeding, accelerated weight gain during infancy, family history of cardiovascular disease, parental hypertension, and body mass index) prematurity was shown to be associated with an increase in systolic blood pressure by 2.87 mmHg (95% confidence interval 0.48–5.27; p = 0.02). Cortisol, androgen metabolite, and aldosterone precursor excretion per day were not higher in individuals born preterm. In contrast to our hypothesis, multiple regression analysis showed prematurity to independently decrease cortisol and aldosterone precursor excretion per day (p < 0.001 and 0.04, respectively).Conclusion: This study provides further evidence for systolic blood pressure to be higher after preterm birth as early as at the age of 5 to 7 years. However, this seems not to be explained by elevated excretion of cortisol and/or androgen metabolites.

Prevalence and risk factors of hypertension among college freshmen in China

Hypertension is the leading single contributor to all-cause death and disability worldwide. However, there is scarce evidence on the prevalence and risk factors of hypertension for Chinese youth. This study aimed to investigate the prevalence of hypertension among Chinese college freshmen and to identify the influencing factors. We conducted a cross-sectional study of all freshmen from 2015 to 2017 at a university in Wuhan, China by physical examination and standard-structured questionnaire. The Pearson chi-square test was used to compare categorical variables. Forward stepwise logistic regression method was used in the multivariate analysis to identify independent predictors of hypertension in youth. A total of 12,849 participants were included, and the prevalence of hypertension of Chinese college freshmen was 4.3% (7.9% in men and 1.6% in women). Men had a higher risk of hypertension than women (odds ratio [OR]: 5.358, 95% confidence interval [CI]: 4.345–6.607, P < 0.001). Obese people were more likely to develop hypertension than those with normal body mass index (OR: 10.465, 95% CI: 8.448–12.964, P < 0.001). People with elevated resting heart rate (RHR) had a higher prevalence of hypertension (OR: 4.987, 95% CI: 3.641–6.832, P < 0.001). Staying up late (OR: 2.957, 95% CI: 2.482–3.523, P < 0.001), physical inactivity (OR: 4.973, 95% CI: 4.141–5.972, P < 0.001), living in urban district (OR: 1.864, 95% CI: 1.493–2.329, P < 0.001) and family history of cardiovascular diseases (CVDs) (OR: 2.685, 95% CI: 2.108–3.421, P < 0.001) were related to higher prevalence of hypertension in youth. Male, obesity, elevated RHR, physical inactivity and family history of CVDs were identified as important risk factors of hypertension in youth. These risk factors should be given more attention when designing and implementing the interventional programs.

Family History is Related to High Risk of Recurrent Events after Ischemic Stroke or Transient Ischemic Attack

ObjectivePrior data suggest paternal or sibling stroke was associated with increased risk of offspring stroke. Whether family history of cardiovascular disease (FHc) predicts risk of stroke recurrence remains unclear, we aim to determine this issue on patients with ischemic stroke (IS) or transient ischemic attack (TIA). Materials and MethodsThis is a post hoc analysis based on the Third China National Stroke Registry III. IS/TIA patients with data of FHc status were included. FHc was defined as family history of coronary heart disease (CHD) or stroke among first-degree relatives (include parents, children, and siblings (same parents)). Cox proportional hazards regression models were performed to assess the association between FHc and recurrent events at 1 year follow-up. ResultsTotally 14,208 patients with verified FHc status were included, 4,454 (31.3%) were female and the median (IQR) age was 62.0 (54.0, 70.0) years. Of these, 294 (2.1%), 726 (5.1%) and 1936 (13.6%) had family history of both CHD and stroke, family history of CHD, and family history of stroke only, respectively. Using multivariable Cox models adjusted for age, sex, and vascular risk factors, we found that patients with FHc experienced higher risk of stroke recurrence (HR=1.151, 95%CI=1.000-1.324) and combined vascular events (HR=1.186, 95%CI=1.036-1.358) at 1 year compared with those without FHc. In sensitivity analysis on patients who received primary secondary prevention treatment of antiplatelet and statins, the association persisted. ConclusionsFHc is associated with increased risk of stroke recurrence even under primary secondary prevention treatment.

Familial factors, diet, and risk of cardiovascular disease: a cohort analysis of the UK Biobank

Both diet and familial factors have a major role in the development of cardiovascular disease (CVD). However, it remains unclear whether familial predisposition to CVD modifies the association between dietary factors and CVD. The aim was to assess whether the association between diet and CVD varies with familial predisposition to CVD. In this prospective cohort of the UK Biobank, 462,155 CVD-free participants were included in 2006-2010 and followed for CVD incidence until 2020. Food intake was measured using a short food-frequency questionnaire. Familial predisposition was measured by self-reported family history of CVD and by polygenic risk score (PRS) for CVD based on summary statistics of independent genome-wide association studies. During a median follow-up of 11.2 y, 46,164 incident CVD cases were identified. A moderately higher risk of CVD was associated with more frequent processed-meat consumption, with an adjusted HR of 1.07 (95% CI: 1.03, 1.11; highest vs. lowest level). Conversely, intakes of fish, cheese, vegetables, and fruit were each associated with reduced CVD risk [HR (95% CI): 0.92 (0.89, 0.96), 0.90 (0.86, 0.94), 0.98 (0.95, 1.00), and 0.93 (0.89, 0.96), respectively]. Stratification analyses by family history of CVD and by PRS for CVD revealed an inverse association between CVD and intakes of fish and cheese, for both subgroups with and without a familial predisposition to CVD. Notably, while the association between processed-meat intake and CVD was restricted to individuals with a familial predisposition to CVD [e.g., HR: 1.11 (1.05, 1.16) and 1.03 (0.97, 1.10) for with and without a family history, respectively, P-interaction<0.001], the risk reduction of CVD associated with vegetable and fruit intake was only noted among participants without a CVD familial predisposition [e.g., HR for fruit consumption: 1.00 (0.97, 1.03) and 0.91 (0.87, 0.95), respectively, P<0.001]. Familial factors modify the association between diet and CVD, underscoring the need for personalized dietary guidelines for CVD prevention.

Cardiovascular disease prediction model for Indonesian adult population with prediabetes and diabetes mellitus: The Bogor Cohort study of Noncommunicable Diseases Risk Factors

Background and aimsThis study aims to develop a predictive model of cardiovascular events in dysglycemia among the Indonesian adult population. MethodsThis is a retrospective cohort study conducted on subjects over 25 years in the “The Bogor Cohort Study of Noncommunicable Diseases Risk Factors” from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed; this included coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events. ResultsA total of 1085 subjects with prediabetes and diabetes mellitus were included in this study, with 73.5% female. The cumulative incidence of cardiovascular events in six years was 9.7%. Predictors of cardiovascular events were age ≥45 years (HR = 2.737; 95% CI 1.565–4.787) and hypertension (HR = 2.580; 95% CI 1.619–4.112). ConclusionsAge ≥45 years and hypertension were predictors of cardiovascular events in six years among the adult Indonesian population with prediabetes and diabetes, necessitating targeted intervention among these subjects.

Health-Related Lifestyle Profiles in Healthy Adults: Associations with Sociodemographic Indicators, Dispositional Optimism, and Sense of Coherence.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Promoting healthy behaviors throughout life is an essential prevention tool. This study investigated the associations among lifestyle profiles (including diet, alcohol consumption, physical activity, cigarette smoking, and cardiovascular screening), sociodemographic factors (gender, age, education, and family history of CVDs), and psychological factors (sense of coherence and dispositional optimism). In total, 676 healthy adults (mean age = 35 years; range = 19–57; 46% male) participated in an online survey. Lifestyle profiles were identified through cluster analysis, and a multinomial logistic regression was then performed to explore their association with sociodemographic and psychological variables. Results show that men were more likely than women to belong to the lifestyle profile with the highest amount of physical activity (OR = 2.40; p < 0.001) and the greatest attention to cardiovascular screening (OR = 2.09; p < 0.01). Lower dispositional optimism was associated with the profile paying the greatest attention to cardiovascular screening (OR = 0.67; p < 0.05). Sense of coherence, in terms of lower comprehensibility (OR = 0.67; p < 0.05) and higher manageability (OR = 1.43; p < 0.05), was associated with the lifestyle profile characterized by an unhealthy diet, sedentary lifestyle, and nonsmoking. This study shed light on factors associated with different co-occurring health-related behaviors that should be considered in planning effective communication strategies promoting adherence to health claims.

Dietary pattern derived by reduced-rank regression and cardiovascular disease: A cross-sectional study

Background and aimsDiet can affect cardiovascular health by changing lipid profiles or obesity levels. However, the association of dietary patterns reflecting lipid metabolism and adiposity measures with cardiovascular disease (CVD) is unclear. This study aimed to derive dietary patterns that explained variation in blood lipids and adiposity and investigate their associations with prevalent CVD. Methods and resultsA cross-sectional study was constructed in Beijing MJ Health Screening Center from 2008 to 2018. A dietary pattern was derived using reduced-rank regression among 75,159 participants without CVD. The dietary pattern explained the largest in predicting lipid profiles and adiposity measures. The dietary pattern was associated with a higher level of LDL-cholesterol and triglyceride, and high body mass index and waist circumference, but lower HDL-cholesterol. The dietary pattern was characterized by high intakes of staple food, red meat, processed food, fried food, edible offal, and less intakes of jam or honey, fruits, milk, and dairy products. Among 89,633 participants, we evaluated its association with prevalent CVD using multivariate logistic regression with adjustment for age, sex, annual income, education attainment, marital status, family history of CVD, smoking status, alcohol use, physical activity, and daily energy intake. Individuals with the highest quintile of dietary pattern score were 1%–38% more likely to have prevalent CVD than the lowest quintile (OR = 1.18, 95% CI = 1.01–1.38). ConclusionA diet pattern reflecting lipid profiles and obesity level was positively related to prevalent CVD, which could provide new insights in optimizing blood lipids and body shape for the prevention of CVD through dietary approaches among the Chinese population.