Family History Of Myocardial Infarction Research Articles

Abstract P218: Longitudinal Changes in Berry Intake and the Risk of Cardiovascular Disease in Women

Background: High intake of polyphenols has been linked to a lower risk of cardiovascular disease (CVD). Berries are high in polyphenols, including anthocyanins, along with other key nutrients. However, few studies have investigated the association between longitudinal changes in berry intake and long-term risk of CVD. The aim of this study was to investigate whether longitudinal changes in berry intake are associated with the risk of major CVD endpoints. Methods: Longitudinal changes in berry intake (sum of blueberries and strawberries) were assessed from two 131-item food-frequency questionnaires (FFQ) completed in 1992-1995 (FFQ1) and 2004 (FFQ2) among 29,598 middle-aged and older women free of CVD from the Women’s Health Study. Women also provided self-reports of a wide range of lifestyle, clinical and dietary factors at both timepoints. For each FFQ, women were categorized into two categories of total berry, blueberry, and strawberry intake: never/rarely and ≥1 time/month. Women were then categorized as having consistent low intake (never/rarely), consistent any intake (≥1 time/month), any increase in intake, and any decrease in intake between FFQ assessments. We used Cox proportional hazards models to calculate age and multivariable-adjusted hazard ratios (HRs) (95% confidence intervals (CI)). We included age, randomization assignments, smoking status, body mass index, physical activity, hormone replacement therapy, family history of myocardial infarction (MI), hypercholesterolemia, hypertension, diabetes, fruit and vegetable intake, saturated fatty acid intake, and omega-3 intake as covariates at the FFQ2 assessment. Results: During a mean follow-up of 9.9 years, we identified 851 cases of incident major CVD (MI, stroke, and CVD death). The intakes of total berries at FFQ1 were 23% (never/rarely) and 77% (≥1 time/month). Corresponding intakes at FFQ2 were 15% and 85%, respectively. In multivariable-adjusted models, consistently having any berry intake (HR: 1.00 (0.78-1.28)), any increase (HR: 0.89 (0.66-1.19)), or any decrease (HR: 0.84 (0.60-1.18)) in total berry intake over 10 years were not significantly associated with the risk of major CVD compared to women with consistently having no intake. A similar lack of association was observed for changes in strawberry intake. Increasing blueberry intake was associated with a lower risk of major CVD (HR: 0.83 (0.69-0.99)), whereas consistently having any blueberry intake (HR: 1.09 (0.91-1.29)) and any decrease in blueberry intake (HR: 0.97 (0.75-1.27)) were not associated with CVD. Conclusions: The results from this prospective study of middle-aged and older women initially free of CVD suggest that increasing blueberry intake over time may lower the risk of subsequent CVD.

Prevalence and determinants of carotid plaque in the cross-sectional REFINE-Reykjavik study

ObjectiveCarotid plaque and intima-media thickness are non-invasive arterial markers that are used as surrogate end points for cardiovascular disease. The aim was to assess the prevalence and severity of carotid...

Associations of cardiovascular disease risk factors with abdominal aortic calcium volume and density: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background and aimsAbdominal aortic calcium (AAC) predicts future cardiovascular disease (CVD) events and all-cause mortality independent of CVD risk factors. The standard AAC score, the Agatston, up-weights for greater calcium density, and thus models higher calcium density as associated with increased CVD risk.We determined associations of CVD risk factors with AAC volume and density (separately). MethodsIn a multi-ethnic cohort of community living adults, we used abdominal computed tomography scans to measure AAC volume and density. Multivariable linear regression was used to determine the period cross-sectional independent associations of CVD risk factors with AAC volume and AAC density in participants with prevalent AAC. ResultsAmong 1413 participants with non-zero AAC scores, the mean age was 65 ± 9 years, 52% were men, 44% were European-, 24% were Hispanic-, 18% were African-, and 14% were Chinese Americans (EA, HA, AA, and CA respectively). Median (interquartile range, IQR) for AAC volume was 628 mm3 (157–1939 mm3), and mean AAC density was 3.0 ± 0.6. Compared to EA, each of HA, AA, and CA had lower natural log (ln) AAC volume, but higher AAC density. After adjustments for AAC density, older age, ever smoking history, higher systolic blood pressure, elevated total cholesterol, reduced HDL cholesterol, statin and anti-hypertensive medication use, family history of myocardial infarction, and alcohol consumption were significantly associated with higher ln(AAC volume). In contrast, after adjustments for ln(AAC volume), older age, ever smoking history, higher BMI, and lower HDL cholesterol were significantly associated with lower AAC density. ConclusionsSeveral CVD risk factors were associated with higher AAC volume, but lower AAC density. Future studies should investigate the impact of calcium density of aortic plaques in CVD.

Family history of myocardial infarction, stroke and diabetes and cardiometabolic markers in children.

Despite the overlap in occurrence of cardiovascular disease (CVD) and type 2 diabetes and their risk factors, family history of these diseases has not yet been investigated simultaneously in relation to cardiometabolic markers in offspring. We examined how a family history of CVD and/or diabetes relates to cardiometabolic markers in offspring, and to what extent these diseases independently contribute to cardiometabolic markers. We used data from 1,374 12-year-old children and their parents participating in a birth cohort study in the Netherlands. Family history of CVD (myocardial infarction [MI] and stroke) and diabetes were reported by the parents. Children were classified as 'no', 'moderate' or 'strong' family history, based on early/late onset of disease in parents and grandparents. Cardiometabolic markers were measured at 12years of age: waist circumference, cholesterol, blood pressure and HbA1c. Compared with those with no family history, children with a strong family history of MI and/or stroke and/or diabetes (29% of the study population) had 0.13mmol/l higher total cholesterol (TC) (95% CI 0.03, 0.23) and 0.18 higher TC/HDL-cholesterol (HDLC) ratio (95% CI 0.04, 0.32). A strong family history of MI or diabetes was independently associated with unfavourable cardiometabolic markers specific to those diseases. These associations remained after adjusting for BMI. Children with a moderate family history had no unfavourable cardiometabolic markers. One-third of the children had a strong family history of CVD and/or diabetes. These children had higher TC levels and TC/HDLC ratios than children with no family history. A strong family history of MI or diabetes was independently associated with unfavourable cardiometabolic markers specific to those diseases.

Preconception Cardiovascular Risk Factor Differences Between Gestational Hypertension and Preeclampsia: Cohort Norway Study.

Preconception predictors of gestational hypertension and preeclampsia may identify opportunities for early detection and improve our understanding of the pathogenesis and life course epidemiology of these conditions. Female participants in community-based Cohort Norway health surveys, 1994 to 2003, were prospectively followed through 2012 via record linkages to Medical Birth Registry of Norway. Analyses included 13 217 singleton pregnancies (average of 1.59 births to 8321 women) without preexisting hypertension. Outcomes were gestational hypertension without proteinuria (n=237) and preeclampsia (n=429). Mean age (SD) at baseline was 27.9 years (4.5), and median follow-up was 4.8 years (interquartile range 2.6-7.8). Gestational hypertension and preeclampsia shared several baseline risk factors: family history of diabetes mellitus, pregravid diabetes mellitus, a high total cholesterol/high-density lipoprotein cholesterol ratio (>5), overweight and obesity, and elevated blood pressure status. For preeclampsia, a family history of myocardial infarction before 60 years of age and elevated triglyceride levels (≥1.7 mmol/L) also predicted risk while physical activity was protective. Preterm preeclampsia was predicted by past-year binge drinking (≥5 drinks on one occasion) with an adjusted odds ratio of 3.7 (95% confidence interval 1.3-10.8) and by past-year physical activity of ≥3 hours per week with an adjusted odds ratio of 0.5 (95% confidence interval 0.3-0.8). The results suggest similarities and important differences between gestational hypertension, preeclampsia, and preterm preeclampsia. Modifiable risk factors could be targeted for improving pregnancy outcomes and the short- and long-term sequelae for mothers and offspring.

Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

ObjectiveTo describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up.MethodsThe systemic lupus international collaborating clinics...

Abstract P227: Cardiovascular Disease (CVD) Risk Factors Have Opposite Associations with Abdominal Aortic Calcium (AAC) Density and Volume: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: AAC predicts future CVD events independently of CVD risk factors. The standard AAC score, the Agatston method, up-weights for greater calcium density, thus models higher calcium density as associated with increased CVD risk. We evaluated this model by investigating associations of CVD risk factors with AAC density and volume separately. Methods: Multivariable linear regression was used to investigate the independent cross-sectional associations of CVD risk factors, markers of inflammation, and potential promoters of calcification with AAC density and ln (AAC volume). AAC density was calculated as: Density = Agatston / (volume, mm 3 / CT scan slice thickness, mm). Agatston = area, mm 2 X density. Results: In 1413 MESA participants with prevalent AAC, mean age was 65 ± 9 years, mean AAC density was 3.0 ± 0.6, 52% were men, 44% were European-, 24% were Hispanic-, 18% were African-, and 14% were Chinese Americans (EA, HA, AA, and CA respectively). In fully adjusted models, older age was non-significantly associated with lower AAC density, but significantly associated with higher ln (AAC volume) (Figure). Compared to EA, we observed AAC density was significantly higher in CA, non-significantly higher HA and AA, but ln (AAC volume) was significantly lower in CA, HA, and AA. Also, smoking, alcohol use, family history of myocardial infarction, higher systolic blood pressure, elevated total cholesterol, and interluken-6 were significantly associated with higher ln (AAC volume), but not AAC density. Lastly, lower body mass index, higher serum HDL and calcium were significantly associated with higher AAC density, but associations with ln (AAC volume) were in the opposite direction. Conclusion: A greater burden of CVD risk factors was associated with higher AAC volume, but not AAC density. Thus, the Agatston method of up-weighting AAC scores for greater density in CVD risk prediction may be inappropriate. Investigators should evaluate separately associations of AAC density and volume with CVD events.

Risk factor exposure in individuals free from cardiovascular disease differs according to age at first myocardial infarction.

The pathophysiology of myocardial infarction (MI) may differ depending on whether it occurs early or late in life. We tested the hypothesis that risk factor pattern differs according to the age at MI. We performed a matched case-control study in the population-based Malmö Preventive Project (n = 33 346), where 3687 individuals developed MI during 22 ± 7 years of follow-up (=cases). The cases were divided into quartiles (Q1-Q4) according to age at event and were assigned two matched controls free from MI during follow-up. We used conditional logistic regression to assess relationship between risk factors at baseline and case status within quartiles of age at incident MI. The median (range) age (years) at incident MI in Q1 was 52.9 (37.0-57.1), Q2 60.8 (57.1-63.6), Q3 66.6 (63.6-69.7), and Q4 73.5 (69.7-84.0). The odds ratio (95% CI) for incident MI associated with 1 SD increase of baseline cholesterol decreased with age of MI and was 1.68 (1.50-1.87) for Q1, 1.43 (1.28-1.61) for Q2, 1.27 (1.14-1.42) for Q3, and 1.08 (0.98-1.19) for Q4. Similarly, family history of MI had a stronger relationship with MI in Q1 than with MI in Q4 of MI age, whereas smoking displayed a U-shaped relationship. Exposure to the remaining risk factors did not differentially affect MI occurring at different age spans. Exposure to cholesterol and family history of MI more strongly predicts onset of MI at younger ages, suggesting that MI in younger subjects is preceded by a different risk factor pattern than MI presenting in older subjects.

Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan.

Background:Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan.Objectives:To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan.Subjects and Methods:This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research.Results:A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05).Conclusion:Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.

Study of association of ABO blood group with ischemic heart disease

Background: Increasing use of blood group distribution in the study of diseases has prompted us to use this technique in an attempt to assess the role of genetic factor in development of ischemic heart disease (IHD). Objectives: To see whether ABO blood group has an independent association with IHD besides other factors such as age, sex, religion, smoking, alcohol, occupation, hypertension, DM, and family history of myocardial infarction. Materials and Methods: This study includes 410 subjects with history of chest pain. The presence of IHD is ruled out by Rose questionnaire followed by ECG and blood grouping. Results: The incidence of IHD was three times more among blood group A and B subjects as compared to blood group O subjects. Conclusion: Significant association of ABO blood group and IHD is present.

The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania.

AimTo evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men.MethodsThe association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972–1974 and 1976–1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality.ResultsAfter adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09–1.42) and for CHD mortality 1.20 (1.02–1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality.ConclusionsFamily history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.

Epidemiology and Management Cost of Myocardial Infarction in North Punjab, Pakistan.

Background:Coronary heart disease (CHD) is an important cause of morbidity and mortality in Pakistan. The temporal trends in the risk factors for myocardial infarction (MI) and the impact of socioeconomic status on these risk factors remain ambiguous.Objectives:The objectives of the present analysis were to investigate the potential association between various risk factors and MI in North Punjab, Pakistan, and to assess the status of the control of the risk factors associated with MI in this population.Patients and Methods:The present study included 515 patients admitted to the coronary care units or equivalent cardiology wards of the participating hospitals between 2011 and 2012 in North Punjab, Pakistan. The analysis was focused on identifying the socioeconomic status, lifestyle, family history of MI, and risk factors (i.e. hypertension, diabetes, smoking, and hyperlipidemia). A structured questionnaire was designed to collect data. The lipid profile was recorded from the investigation chart of every patient. For statistical analysis, the Kruskal Wallis, Mann-Whitney U, Wilcoxon, and chi-square tests were used.Results:MI was common in the males at the age of 41 - 60 years as compared to the females (P = 0.015). Patients with a positive parental history of CHD experienced MI at a younger age (P = 0.0001) at a body mass index (BMI) ≤ 25 kg/m2. Sedentary lifestyle (70%) and smoking (60%) had a male predominance. Hypertension accounted for nearly 37%, hyperlipidemia 26%, and diabetes 19.4% of the rural and urban subjects (P < 0.01). High-density lipoprotein cholesterol decreased (up to 34 mg/dl), while low-density lipoprotein cholesterol and hypertension increased with age. The mean monthly cost of medicines and physicians’ fees per patient was 2381.132 Pakistani Rupees (24.24 USD).Conclusions:Higher BMI, positive family history, smoking, hypertension, hyperlipidemia, and diabetes were the strong predictors of MI in North Punjab, Pakistan. Preventive efforts are needed to start early in life and continue throughout the life course.

A detailed family history of myocardial infarction and risk of myocardial infarction--a nationwide cohort study.

BackgroundFamily history of myocardial infarction (MI) is an independent risk factor for MI. Several genetic variants are associated with increased risk of MI and family history of MI in a first-degree relative doubles MI risk. However, although family history of MI is not a simple dichotomous risk factor, the impact of specific, detailed family histories has not received much attention, despite its high clinical relevance. We examined risk of MI by MIs in first- and second-degree relatives and by number and age of affected relatives.Methods and FindingsUsing Danish national registers, we established a nationwide cohort of persons born between 1930 and 1992 with identifiable first- or second-degree relatives. Incident MIs in both cohort members and relatives aged ≥20 years were identified. We calculated incidence rate ratios (IRRs) for MI by family history of MI, by Poisson regression. In 4.4 million persons followed for 104 million person-years, we identified 128,384 incident MIs. IRRs with 95% confidence intervals [CIs] for MI by history of MI in 1, 2 or ≥3 first-degree relatives were 1.46 (1.42-1.49), 2.38 (2.22-2.56) and 3.58 (2.66-4.81), respectively. Corresponding estimates for second-degree relatives were 1.17 (1.05-1.30), 1.87 (1.46-2.38) and 2.18 (1.09-4.36). A history of MI in combinations of first- and second-degree relatives increased risks 1.8- to 7-fold in middle-aged persons (36 to 55 years). Estimates were robust to adjustment for diabetes, hypertension, dyslipidemia and use of cardiovascular medications.ConclusionA detailed family history, particularly number of affected first- and second-degree relatives, contributes meaningfully to risk assessment, especially in middle-aged persons. Future studies should test for potential improvement of risk algorithm prediction using detailed family histories.

Disease activity in rheumatoid arthritis and the risk of cardiovascular events.

Use of several immunomodulatory agents has been associated with reduced numbers of cardiovascular (CV) events in epidemiologic studies of rheumatoid arthritis (RA). However, it is unknown whether time-averaged disease activity in RA correlates with CV events. We studied patients with RA whose cases were followed in a longitudinal US-based registry. Time-averaged disease activity was assessed during followup using the area under the curve of the Clinical Disease Activity Index (CDAI), a validated measure of RA disease activity. Age, sex, presence of diabetes mellitus, hypertension, or hyperlipidemia, body mass index, family history of myocardial infarction (MI), use of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), presence of CV disease, and baseline use of an immunomodulator were assessed at baseline. Cox proportional hazards regression models were examined to determine the risk of a composite CV end point that included MI, stroke, and death from CV causes. A total of 24,989 patients who had been followed up for a median of 2.7 years were included in these analyses. During followup, we observed 534 confirmed CV end points, for an incidence rate of 7.8 per 1,000 person-years (95% confidence interval [95% CI] 6.7-8.9). In models adjusted for variables noted above, a 10-point reduction in the time-averaged CDAI was associated with a 21% reduction in CV risk (95% CI 13-29). These results were robust in subgroup analyses stratified by the presence of CV disease, use of corticosteroids, use of NSAIDs or selective cyclooxygenase 2 inhibitors, and change in RA treatment, as well as when restricted to events adjudicated as definite or probable. Our findings showed that reduced time-averaged disease activity in RA is associated with fewer CV events.

Abstract 156: Everyday Discrimination and Risk of Myocardial Infarction Among Women

Background: Discrimination, a form of chronic psychological stress, is related to certain chronic health conditions such as poor physical health and hypertension. However, little is known about the associations of everyday discrimination with risk of myocardial infarction. Methods and Results: We assessed the association between everyday discrimination (discrimination) and myocardial infarction (MI) using a prospective, nested case control study of 548 women (267 cases, 281 controls), selected from 26,763 women without a history of cardiovascular disease at baseline who participated in the Women’s Heath Study (WHS). Among 267 MI cases, there was a mean follow-up of 8.8 + 4.1 years from date of WHS randomization to date of MI event. At baseline, the mean age of participants was 53.6 + 6.1 years. Cases and controls were matched for age and smoking history. Discrimination was assessed by 5 questions where women reported whether they were: 1) treated with less courtesy/respect than others; 2) treated as not being smart; 3) treated as if others were afraid of them; 4) received poorer service at restaurants/stores; or 5) felt threatened/harassed. Responses were based on a Likert scale of 1=never to 5=at least once/weekly with higher scores indicating more experiences with discrimination. In unadjusted logistic regression models of increasing tertiles of discrimination, we found no significant association between discrimination and odds of MI [Odds Ratios (OR) and 95% confidence intervals (95%CI): 1.00, 1.28 (0.85-1.94), 1.06 (0.69-1.64); p trend =0.5]. Adjustment for cardiovascular disease risk factors (lipid parameters, hsCRP, family history of MI, hypertension, body mass index, diabetes, and alcohol consumption) revealed an inverse-U-shaped relationship [OR, 95%CI: 1.00, 2.14 (1.21-3.77), 1.55 (0.87-2.78); p trend = 0.03], suggesting that these factors obscured the association in unadjusted models. Notably, addition of education and income to the crude model alone [1.00, 1.38 (0.89, 2.15), 0.97 (0.61, 1.54) p trend = 0.2] or to the model with the cardiovascular risk factors [1.00, 2.27 (1.25-4.10), 1.36 (0.73, 2.53); p trend = 0.02] had minimal impact on odds of MI in these women. Conclusion: Among women participating in the WHS follow-up cohort, higher levels of everyday discrimination were related to increased odds of myocardial infarction in an inverse-U-shaped manner, a finding that is obscured by traditional cardiovascular disease risk factors. Access to measures associated with a healthy heart might be important to myocardial infarction risk attenuation among women reporting everyday discrimination. Further research is warranted to elucidate the relationship between everyday discrimination and increased risk of MI.

English

BACKGROUND & OBJECTIVES: Patients with Rheumatoid Arthritis (R.A.) have a marked increase in Carotid Atherosclerosis independent of traditional risk factors like family history of myocardial infarction in first degree male relatives younger than 55 years of age or first degree female relatives younger than 65 years of age, smoking, hypertension (Defined as blood pressure of 140/90 mm hg or higher), diabetes mellitus and fasting serum cholesterol levels including age. Chronic inflammation and possibly disease severity and duration are atherogenic in Rheumatoid Arthritis patients. Preclinical disease may also be identified by using ultrasonography to determine carotid intimal-media thickness, an indirect measure of atherosclerosis. The common carotid artery Intima media thickness in Rheumatoid Arthritis patients is positively associated with disease duration, Early Rheumatoid Arthritis (Duration less or = 1 year) is associated with lesser Intima media thickness than was Rheumatoid Arthritis of longer duration. Increased carotid artery Intima media thickness and the presence of carotid plaque are associated with markers of systemic inflammation in patients with Rheumatoid Arthritis and in healthy subjects. OBJECTIVE OF THE STUDY: To determine preclinical atherosclerosis occurring prematurely in patients of Rheumatoid Arthritis by ultrasonograhic measurement Common Carotid Artery Intima media thickness and to evaluate the risk factors associated with arterial intima media thickness in patient of Rheumatoid Arthritis. RESULTS: In RA patients, common carotid artery IMT was significantly higher when compared to healthy controls (0.65 ± 0.06 v/s 0.57 ± 0.049) and was significantly associated with the duration of RA, swollen joint count and erosive changes on hand x-ray independently of other confounding variables. CONCLUSION: Patients with rheumatoid arthritis have a marked increase in carotid atherosclerosis independent of traditional risk factors, including age. Carotid ultrasonography is a simple and inexpensive way of identifying preclinical atherosclerosis in this highly vulnerable population. In addition to prospective management of traditional risk factors, there is a need for aggressive control of rheumatoid arthritis disease activity because chronic inflammation is a driving force for premature atherosclerosis.

Characteristics of risk factors in young and middle-aged patients with first hemispheric ischemic stroke

To compare risk factors of the first hemispheric ischemic stroke in young, middle and old age groups. One hundred and thirteen patients with first hemispheric ischemic stroke confirmed by CT/MRI were examined. The patients were divided into 2 groups: young and middle-aged (51 patients, 24 women, 27 men, mean age 49.8±5.2) and advanced-aged (62 patients, 30 women, 32 men, mean age 76.4±7.5). The frequency and duration of the following risk factors for ischemic stroke, including arterial hypertension, ischemic heart disease and arrhythmias, diabetes, smoking, family history of myocardial infarction and/or stroke, body mass index, acute emotional stress before the onset of the disease, were compared. Results of echocardiography, Holter and blood pressure monitoring, total cholesterol, low and high-density lipoproteins, triglycerides and blood glucose were analyzed. In young and middle-aged patients, an increased variability of blood pressure, acute emotional stress before the onset of stroke, a family history of cardiovascular and/or cerebrovascular disease, a decreased level of high-density lipoproteins, silent myocardial ischemia on Holter monitoring, mitral and tricuspid valve prolapse, minor abnormalities of the heart were more frequent than in the advanced age group. There are age-related differences in the spectrum and frequency of risk factors in patients with first hemispheric ischemic stroke. This fact should be taken into account in stroke prevention programs in various age groups.

Abstract 16411: Abo Blood Group and Risk of Myocardial Infarction in Hispanics

Hypothesis: ABO blood group has been associated with myocardial infarction (MI) in Caucasians. This study evaluated whether genotype-derived ABO blood group associated with MI in Hispanics, and whether lifestyle risk factors modified the associations. Methods: Cases (n=2273) with a first acute nonfatal MI and population-based controls (n=2274) living in Costa Rica were studied. Five ABO single-nucleotide polymorphisms (SNPs) were genotyped. RESULTS: Three SNPs (rs687289, rs507666, and rs579459) at ABO locus showed significant associations with MI risk, with odds ratios (ORs, 95% confidence interval) of 1.17(1.05-1.30), 1.18(1.05-1.32), and 1.14(1.02-1.28), respectively. Compared to subjects with blood group O, the ORs for blood group A, AB and B were 1.24 (95% CI, 1.08-1.43), 1.15 (95% CI, 0.95-1.39), and 1.10 (95% CI, 0.77-1.57), respectively. Subjects with non-O blood group had an adjusted OR for MI of 1.20 (95% CI, 1.05-1.37) when compared to subjects with O blood group after adjustment for age, sex, area of residence, smoking, alcohol consumption, physical activity, total calories, and family history of MI. CONCLUSIONS: Our results indicate both the consistency and disparity of ABO genetic effects on MI risk between Hispanics and Caucasians.

Family history of myocardial infarction as a strong independent predictor of in-stent restenosis in the era of drug eluting stents

Family history of myocardial infarction as a strong independent predictor of in-stent restenosis in the era of drug eluting stents

Family history of myocardial infarction and cause-specific risk of myocardial infarction and venous thromboembolism: the Tromsø Study.

A family history of myocardial infarction (FHMI) has been shown to increase the risk of venous thromboembolism (VTE). The mechanism underlying the association remains unclear. Therefore, we aimed to determine the risks of MI and VTE by FHMI using a cause-specific model and to explore whether atherosclerotic risk factors could explain the association between FHMI and VTE in a population-based cohort. The study included 21 624 subjects recruited from the Tromsø Study in 1994 to 1995 and 2001 to 2002. Incident MI and VTE events were registered from date of enrollment to end of follow-up, December 31, 2010. There were 1311 MIs and 428 VTEs during a median follow-up of 15.8 years. FHMI was associated with a 52% increased risk of MI (adjusted hazard ratio, 1.52; 95% confidence interval, 1.35-1.70) and a 26% increased risk of VTE (adjusted hazard ratio, 1.26; 95% confidence interval, 1.02-1.55) in the cause-specific Cox model. Similar results were found using the traditional Cox model. The risk estimates by status of FHMI were highest for unprovoked deep vein thrombosis (adjusted hazard ratio, 1.69; 95% confidence interval, 1.12-2.56), and the risk increased with increasing number of affected relatives. Modifiable atherosclerotic risk factors slightly altered the association between FHMI and MI but had a negligible effect on the association between FHMI and VTE. FHMI was associated with increased risk of both MI and VTE in a cause-specific model. Apparently, the association between FHMI and VTE applied to unprovoked deep vein thrombosis and was not explained by modifiable atherosclerotic risk factors.