Fatal CVD Research Articles

P5295Stable and temporal metabolically benign obesity and cardiovascular disease onset in males and females: the missing link with adiponectin

Abstract Background/Introduction Metabolically healthy obesity (MHO) status has been recently conferred to be a transient condition with cohorts revealing that a considerable proportion, from 33% to 52%, lose their status over time. Purpose To evaluate the stability of MHO, its effect on 10-year first fatal/non fatal CVD onset and the mediating effect of adiponectin. Methods A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants; of them, n=317 incident cases were identified. Obesity was defined as body mass index≥30kg/m2 and healthy metabolic status as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Circulating adiponectin level was measured at baseline (4.0 (2.0) μg/mL). Results MHO prevalence reached 4.8% (n=146) (4.9% in males and 4.7% in females, p=0.198). 28.2% of obese participants presented a metabolically benign status at baseline. In the 5-year follow-up period, transition to metabolically unhealthy status was observed for 33% of MHO participants. Within the decade, almost half of MHO participants resulted as metabolically unhealthy obese. Unadjusted analysis revealed that stable vs. temporal MHO subjects had better lifestyle (i.e. higher adherence to Mediterranean diet and better physical activity status) at the recruitment (all ps<0.05). Temporal MHO subjects presented lower adiponectin values (2.8 (1.1) μg/mL) compared with their stable MHO counterparts (4.1 (1.9) μg/mL) (p<0.05). Multivariate Cox regression analysis revealed no significant discrepancies on 10-year CVD risk between MHO and metabolically healthy non-obese subjects (Hazard Ratio (HR)=0.95, 95% Confidence Interval (95% CI) 0.37, 2.08, p=0.32). Only the subset of temporal MHO subjects reached the level of significance (HR=1.43, 95% CI 1.02, 2.01, p=0.04). Stable MHO status was not independently associated with 10-year CVD risk (p>0.05). Low vs. high adiponectin level was associated with ∼1.3 times higher 10-year risk to move from MHO to metabolically unhealthy obesity status (HR=1.33 95% CI 1.10, 4.02). Sensitivity analyses revealed that adiponectin had a significant interacting effect on the examined associations (p for interaction=0.01); stratified analysis using the mean value of adiponectin to define the strata revealed that MHO (stable or temporal) status was positively associated with 10-year CVD event only in participants with low adiponectin levels i.e. below the mean value of 4.1 μg/mL (HR=1.45 95% CI 1.19, 3.68). Conclusions Weight management is needed to prevent cardiometabolic features even in participants with increased weight status with healthy metabolic status. It is noteworthy that adiponectin may be an underlying path of the stability and CVD risk corresponding to this intermediate condition probably related with insulin resistance and other relevant paths. Acknowledgement/Funding The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer

IntroductionCardiovascular disease (CVD) is an important cause of death in breast cancer survivors. Some breast cancer treatments including anthracyclines, trastuzumab and radiotherapy can increase the risk of CVD, especially for...

252-OR: Cardiorespiratory Fitness Predicts Lower Mortality Rates in Type 2 Diabetes

Look AHEAD was a randomized multi-center clinical trial comparing effects of an intensive lifestyle intervention (ILI) with diabetes support and education (DSE) on CVD events in 5145 adults aged 45-76 years who were overweight or obese and had type 2 diabetes. After 10 years of follow-up, the ILI had no significant effect on the primary outcome of fatal or non-fatal CVD events or on all-cause or CVD mortality rates. We now present a secondary analysis of the effects of cardiovascular fitness at baseline on mortality in 4865 participants. Fitness was defined as the metabolic equivalence (METs) level achieved during maximal workload on a treadmill. For all participants, the mean (SD) were 7.20 (1.97) METs. The all-cause death rate was 14% lower per 1 MET greater fitness at baseline, adjusted for age, sex, race/ethnicity, CVD history, BMI and treatment group (HR 0.86 95% CI 0.80 -0.92). In this model, CVD history (HR 1.82 95% CI 1.42-2.35) but not ILI (HR 0.87 95% CI 0.71-1.07) significantly predicted mortality. Similarly, CVD mortality was 28% lower per 1 MET (HR 0.72, 95% CI 0.62-0.83). Fitness was similarly protective from the other CVD outcomes. The Figure shows all-cause mortality rates modeled by history of CVD, treatment group, age 60 years, and white men not on beta blockers because they were the largest population in the dataset. In conclusion, fitness measured by maximal workload on a treadmill was highly predictive of CVD and mortality. Disclosure A.C. Wills: None. W.C. Knowler: None. J. Curtis: None. M.T. Olaiya: None. Funding National Institutes of Health

Early smoking-onset age and risk of cardiovascular disease and mortality

Early smoking onset age (SOA) is a public health concern with scant empirical evidence of its role in health outcomes. The study had two aims: i) to assess whether an early SOA was associated with the risk of fatal and non-fatal CVD and all-cause and CVD mortality and ii) to explore the linear and non-linear association between SOA and the outcomes of interest. Data from 4499 current or former smokers, recruited from 1995 to 2005, aged 25 to 79 years, and with a median 7.02 years of follow-up, were obtained from the REGICOR population-based cohort. In the present analysis, performed in 2018, the independent variable was SOA and the dependent variables were CVD events, CVD mortality, and all-cause mortality. Penalized smoothing spline methods were used to assess the linear and non-linear association. During follow-up, 361 deaths and 210 CVD events were recorded. A significant non-linear component was identified in the association between SOA and CVD outcomes with a cut-off point at 12 years: In the group aged ≤12 years, each year of delay in SOA was inversely associated with CVD risk (HR = 0.71; 95%CI = 0.53–0.96) and CVD mortality (HR = 0.58; 95%CI = 0.37–0.90). No association was observed in the older SOA group. A linear association was observed between SOA and all-cause mortality, and each year of delay was associated with 4% lower risk of mortality (HR = 0.96; 95%CI = 0.93–0.98). The associations were adjusted for lifelong exposure to tobacco and cardiovascular risk factors. These results reinforce the value of preventing tobacco use among teenagers and adolescents.

The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent.

AimsThe data regarding the associations of body mass index (BMI) with cardiovascular (CVD) risk, especially for those at the low categories of BMI, are conflicting. The aim of our study was to examine the associations of body composition (assessed by five different measures) with incident CVD outcomes in healthy individuals.Methods and resultsA total of 296 535 participants (57.8% women) of white European descent without CVD at baseline from the UK biobank were included. Exposures were five different measures of adiposity. Fatal and non-fatal CVD events were the primary outcome. Low BMI (≤18.5 kg m−2) was associated with higher incidence of CVD and the lowest CVD risk was exhibited at BMI of 22–23 kg m−2 beyond, which the risk of CVD increased. This J-shaped association attenuated substantially in subgroup analyses, when we excluded participants with comorbidities. In contrast, the associations for the remaining adiposity measures were more linear; 1 SD increase in waist circumference was associated with a hazard ratio of 1.16 [95% confidence interval (CI) 1.13–1.19] for women and 1.10 (95% CI 1.08–1.13) for men with similar magnitude of associations for 1 SD increase in waist-to-hip ratio, waist-to-height ratio, and percentage body fat mass.ConclusionIncreasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures. Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged. Take home figureThe obesity paradox is mainly due to the effect of confounding on BMI and disappears on other adiposity measures.

Development of algorithms for identifying fatal cardiovascular disease in Medicare claims.

Cause of death is often not available in administrative claims data. To develop claims-based algorithms to identify deaths due to fatal cardiovascular disease (CVD; ie, fatal coronary heart disease [CHD] or stroke), CHD, and stroke. Reasons for Geographic and Racial Differences in Stroke (REGARDS) study data were linked with Medicare claims to develop the algorithms. Events adjudicated by REGARDS study investigators were used as the gold standard. Stepwise selection was used to choose predictors from Medicare data for inclusion in the algorithms. C-index, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to assess algorithm performance. Net reclassification index (NRI) was used to compare the algorithms with an approach of classifying all deaths within 28days following hospitalization for myocardial infarction and stroke to be fatal CVD. Data from 2,685 REGARDS participants with linkage to Medicare, who died between 2003 and 2013, were analyzed. The C-index for discriminating fatal CVD from other causes of death was 0.87. Using a cut-point that provided the closest observed-to-predicted number of fatal CVD events, the sensitivity was 0.64, specificity 0.90, PPV 0.65, and NPV 0.90. The algorithms resulted in positive NRIs compared with using deaths within 28days following hospitalization for myocardial infarction and stroke. Claims-based algorithms for discriminating fatal CHD and fatal stroke performed similarly to fatal CVD. The claims-based algorithms developed to discriminate fatal CVD events from other causes of death performed better than the method of using hospital discharge diagnosis codes.

Comparison of ten-years risk of fatal cardiovascular events calculated by heartscore in diabetic patients with and without post-traumatic stress disorder (PTSD) comorbidity

IntroductionCardiovascular diseases (CVD) are the leading cause of death and disability-adjusted life years lost globally. Recent studies have shown that post-traumatic stress disorder (PTSD) predicts higher risk of cardiometabolic diseases, specifically cardiovascular disease and diabetes type 2.AimsTo assess cardiovascular event risk differences between diabetic patients with and without PTSD comorbidity.ObjectivesTo explore a ten-year risk of fatal CVD events in diabetic patients with and without PTSD; to gain better insight in potential different functioning patterns in these patient subgroups.MethodsWe investigated a cross-sectional sample consisting of 390 psychiatric inpatients and outpatients. Ten-years risk of fatal CVD events calculated by HeartScore, European society of cardiology. Europe high-risk version was used. The risk estimation is made based on: gender, age, smoking, systolic blood pressure and total cholesterol.ResultsBy analysis of covariance, we controlled possible confounding effects of gender, age, education, marital status, number of household members, work status, average monthly income per household member, body mass index (kg/m2), number of somatic comorbidities, number of psychiatric comorbidities, duration of PTSD, clinical global impression scale–severity of PTSD at diagnosis. After the adjustment for all these variables, interaction of PTSD and T2DM was significantly associated with CVD risk (P < 0.001; Eta2 = 0.04).ConclusionA significant fatal CVD event risk differences between diabetic patients with and without PTSD comorbidity were found. Better awareness of possible underlying determinants provides better optimal individual approach planning, likewise effective prevention and control of cardiovascular diseases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

CONCOMITANT DISEASES AND RISK FACTORS FOR THEIR DEVELOPMENT IN PATIENTS WITH HIV INFECTION OLDER THAN 40 YEARS

Objective: Evaluation of CVD and their risk factors in Russian 40+ HIV-infected patients is a key objective of the study. Materials and Methods: A retrospective analysis of 1872 medical records of 40+ HIV-infected patients from 12 regions of Russia on HAART was performed, including assessment of CVD presence, their risk factors and 10-years CVD risk based on SCORE. All patients received ARV treatment; the average duration of admission was 5 years (1 – 2 years – 43%, 3 – 5 years – 29%, over 5 years – 28%). Results: High incidence of CVD was observed: hypertension – 48%, including cerebrovascular disease – 2%; CAD – 9%, including myocardial infarction – 6%. Analysis of cardiovascular risk factors showed that 19% were overweight, lipid metabolism disorders were detected in 30% of patients, diabetes in 5%. 51% of patients smoked, systematic intake of alcohol in 61% of patients. 69% of patients had a risk of fatal CVD within 10 years based on SCORE, 16% of patients had a high/very high risk. Analysis of metabolic parameters showed that 99,4% of patients needed lifestyle improvement measures, 85% needed lipid lowering medication. One third of patients were constantly taking cardiovascular medications. Conclusions: CVD and metabolic disorders are more common for 40+ HIV-infected patients than for general population. ART assessment in 40+ patients additionally to viral load and CD4 level, should include analysis of cardiovascular risk factors and comorbidities. In elder patients ART regimen choice is particularly important, considering the risks of development and/or progression of CVD and risk of drugdrug interactions development.

LBPS 02–42 ADDITIONAL TOOL TO IMPROVE ADHERENCE TO LIFESTYLE MODIFICATION AND MEDICATIONS.

Objective: Non-adherence and weak adherence to lifestyle modification and medications remain problem in the most subjects with mediate and high risk for development of cardiovascular diseases. Motivational interview with use of European Heart SCORE risk calculator is a good tool to increase adherence to lifestyle change and medications. Design and Method: We decided to study the impact of common use of SCORE and figures of statistical data demonstrating risk of lung cancer according to duration and intensity of smoking and according to age men stop smoking. Total of 48 men, age from 40 to 60, SCORE > 10, all heavy smokers (10–40 cigarettes per day), 65% with Hypertension (stage I-II-JNC 7), 80%- with high total cholesterol were divided into two groups:1-st group were interviewed with calculation by SCORE tool without demonstration additional figures of statistics of risk of smoking for cancer, 2-nd group were interviewed with presentation of these figures additionally to SCORE risk calculator. Results: After 1 year follow up period, males from the 2-nd group more significantly reduced daily cigarettes consumption compare to the 1-st group, adherence to antihypertensive medications, statins and aspirin was higher in the 2-nd group, but not significantly. Conclusions: Traditional 10 year risk calculator of fatal CVD - HEARTSCORE is an effective tool to improve adherence to lifestyle modification and medications but becoming more effective when use with cancer risk figures.

Blood Pressure-Related Outcomes in a Diabetic Population.

See related article, pp 71–77 There has been significant controversy during the past decade about what is appropriate blood pressure control to optimally reduce cardiovascular disease– (CVD) and kidney disease–related events in patients with diabetes mellitus. The recent discussion on blood pressure targets in diabetes mellitus sets the stage for a thought-provoking contribution by Wu et al1 who reported that individuals with diabetes mellitus with persistently low pressures <120/80 mm Hg or pressures that drop below 120/80 mm Hg have an increase in CVD events and mortality over time. On the basis of data derived from larger clinical trials in those with diabetes mellitus, the seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure advised a 130/80 mm Hg target.2 However, achieved systolic blood pressures in those trials were rarely below 130/80 mm Hg and limited to only a few studies.3,4 The Action of Control Cardiovascular Risk in Diabetes (ACCORD) trial was then designed to investigate whether targeting pressures in patients with diabetes down to 120/80 mm Hg would improve CVD outcomes to a greater extent than a goal of <140/90 mm Hg. At end of trial, the overall CVD results were null, but stroke was reduced in those with achieved pressures of <120/80 mm Hg.5 Another recent trial, the Systolic Blood Pressure Intervention Trial (SPRINT), was designed to investigate whether pressures <120/80 mm Hg would improve outcomes in patients with kidney disease compared with 140/90 mm Hg. The SPRINT investigators reported an improvement in fatal and nonfatal major CVD events in the intensive arm <120/80 mm Hg.6 Although …

Metabolic syndrome, adherence to the Mediterranean diet and 10-year cardiovascular disease incidence: The ATTICA study

Background and aimsTo better understand the metabolic syndrome (MS) spectrum through principal components analysis and further evaluate the role of the Mediterranean diet on MS presence. MethodsDuring 2001–2002, 1514 men and 1528 women (>18y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011–2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III) definition. Adherence to the Mediterranean diet was assessed using the MedDietScore (range 0–55). ResultsFive principal components were derived, explaining 73.8% of the total variation, characterized by the: a) body weight and lipid profile, b) blood pressure, c) lipid profile, d) glucose profile, e) inflammatory factors. All components were associated with higher likelihood of CVD incidence. After adjusting for various potential confounding factors, adherence to the Mediterranean dietary pattern for each 10% increase in the MedDietScore, was associated with 15% lower odds of CVD incidence (95%CI: 0.71–1.06). For the participants with low adherence to the Mediterranean diet all five components were significantly associated with increased likelihood of CVD incidence. However, for the ones following closely the Mediterranean pattern positive, yet not significant associations were observed. ConclusionResults of the present work propose a wider MS definition, while highlighting the beneficial role of the Mediterranean dietary pattern.

Using primary care data to evaluate the 10-year cost-effectiveness of cardiovascular disease risk algorithms in patients with serious mental illness: a patient level simulation

Methods Patient data was extracted from The Health Improvement Network (THIN), a primary care database, to populate the patient level simulation. Patients had SMI, were aged 30 to 74 years and free of CVD. A CVD risk algorithm was applied and patients scoring above 10% prescribed statins. We tested four CVD risk algorithms against no algorithm; lipid and body mass index (BMI) versions of SMI specific and general population algorithms. Time dependent transition probabilities for fatal and non-fatal CVD events were calculated using survival analysis. Utility scores to calculate quality adjusted life years (QALYs) were obtained from the literature.

Hierarchical modelling of blood lipids' profile and 10-year (2002-2012) all cause mortality and incidence of cardiovascular disease: the ATTICA study.

BackgroundThe traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids’ profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study. MethodsFrom May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011–12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids’ profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein–(a) levels were also measured.ResultsThe 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000–1.013), 1.006 (1.000–1.013), 1.002 (1.000–1.004), 1.038 (1.001–1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively).ConclusionElevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.

Is Calculated SCORE Risk Reliable in Asymptomatic Atherosclerosis? Sarajevo Survey on Vascular/Heart Ageing

Aim: Aim of this article is to present our own, Bosnia and Herzegovina survey in patients with asymptomatic atherosclerosis and to compare European SCORE risk estimation and 2008 Framingham Risk tables on our sample of patients. In fact, 2008 Framingham Risk table included a concept of vascular/heart ageing. On the other hand a European SCORE system was basically aimed to quantify the absolute 10 years (fatal) cardiovascular risk. SCORE risk estimation and vascular ageing was modify in updated version of European guidelines but still it is insufficient. Cuende et al. (2010) suggests a new method of cardiovascular risk evaluation. Materials-Methods: Sarajevo survey was conducted on the sample of completely (100%) asymptomatic patients (n-358). Participants were of 40-69 yrs, average yrs. 57.1 9.2, 142 females and 216 males. We performed non-invasive screening of aorta, carotid, iliac and femoral vessels and found asymptomatic atherosclerotic disease (atheroplaques) in 43,1% individuals and significance was of p<0,001. We found atherosclerotic plaques of various degrees in age subgroups; 40-49 yrs (18,3%), 50-59 yrs (48,9%), 60-69 yrs (32,7%). Calculation of fatal CVD risk on the basis of SCORE scale for high-risk European countries, due to age subgroups, was as follows; 40-49 yrs (2%), 50-59 yrs (3,45%) and 60-69 yrs (8,90%), respectively. Due to Cuende modification of SCORE tables their average vascular/heart age was significantly higher than their actual calendar age, and average vascular/heart age was higher for 14,5 yrs, p<0,001. After this results we underwent recalculating of vascular/heart age according to 2008 Framingham Risk Tables and we found 16,8 yrs higher results i.e. in age subgroup of 50-59 yrs, vascular/heart age was 75,9 yrs, and for age subgroup of 60-69 yrs, vascular/heart age was 85,3 yrs. Conclusion: after these results we can confirm that current SCORE system underestimate real risk, especially in individuals with asymptomatic atherosclerosis and do not “recognized“ them as high risk population. On the other hand it is very clear that official statistics for Bosnia and Herzegovina; morbidity of 11.800/100000 inhabitants, and mortality of 578/100000, are not correct. In fact, morbidity and mortality in our population is much more higher. On the basis of this results and other studies, as well, we must introduced risk estimation of cardiovascular risk factors on the basis of vascular/heart age to achieve real data and real “mirror“ of our cardiovascular situation. We want to underline that we have to focused on identification of risk and highrisk asymptomatic individuals and immediately act in order to decrease our rates of morbidity and mortality.

Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study

The contribution of sufficient sleep duration to lower CVD risk in addition to sufficient physical activity, a healthy diet, (moderate) alcohol consumption, and non-smoking has not been investigated yet. The MORGEN study is a prospective cohort study including 8128 men and 9759 women aged 20-65 years, free of CVD at baseline. Sufficient physical activity (≥3.5 h/week cycling or sports), a healthy diet (Mediterranean Diet Score ≥5), (moderate) alcohol consumption (≥1 beverage/month), non-smoking, and sufficient sleep duration (≥7 hours) were assessed by self-administered questionnaires between 1994 and 1997. Cardiovascular morbidity and mortality were ascertained through linkage with national registers. Hazard ratios and preventable proportions were calculated adjusted for age, sex, and educational level. During 10-14 years of follow up, 607 composite CVD events (fatal CVD, nonfatal myocardial infarction and stroke) occurred, of which 129 were fatal. Those with the four traditional healthy lifestyle factors had a 57% lower risk of composite CVD (HR 0.43, 95% CI 0.31-0.59) and a 67% lower risk of fatal CVD (HR 0.33, 95% CI 0.16-0.68) compared with those with none or one healthy lifestyle factor. Sleeping sufficiently in addition to the four traditional lifestyle factors resulted in a 65% lower risk of composite CVD (HR 0.35, 95% CI 0.23-0.52), and an 83% lower risk of fatal CVD (HR 0.17, 95% CI 0.07-0.43). Sufficient sleep and adherence to all four traditional healthy lifestyle factors was associated with lower CVD risk. When sufficient sleep duration was added to the traditional lifestyle factors, the risk of CVD was further reduced.

OP0100 Gout in patients with stable coronary heart disease and the impact of serum uric acid levels on adverse cardiovascular outcomes: A long-term follow-up study

BackgroundA relationship between hyperuricemia or gout and cardiovascular disease has been described in many studies. However, it is unclear whether the association between serum uric acid (SUA), inflammatory cytokines and...

Abstract 18787: Population-Based Data from Western Alaska Native People Show High Rates of CHD and Stroke Mortality: The WATCH Study

Background: Early low rates of CVD among Western Alaska native people were attributed to consumption of omega-3 rich foods. Mortality data suggest that rates are rising, but no population-based data have been reported. Methods: The Western Alaska Tribal Collaborative for Health (WATCH) combines three ongoing population-based studies - EARTH, CANHR, and GOCADAN, as well as data from the ASP. The consolidated cohort, the largest study of Western Alaska Native people, consists of 4,569 men and women &gt;18 yrs of age who underwent baseline exams between 2000 and 2010 and were followed an average of 6.7 years (&lt;1% lost to follow-up). CHD, stroke, and all CVD mortality were reviewed and adjudicated using standardized criteria. CHD deaths included MI, definite sudden death due to CHD, and definite fatal CHD. Stroke included those with evidence of rapid fatal onset of localized neurologic deficit or imaging consistent with stroke. CVD included CHD, stroke, and other fatal CVD. Age-adjusted rates (to the 2000 US census) were compared with those of US Whites and Blacks. Results: The baseline cohort was 54% female (mean age 40y for men and 42y for women) (Table). After an average 6.7 years, there were a total of 48 CVD deaths, 30 from CHD, and 17 from stroke. In Western Alaska native people, CHD mortality was similar to that of US Whites, with mortality in men exceeding that in women, but somewhat lower than rates for US Blacks; stroke mortality was similar in men and women, exceeding rates in both US Whites and Blacks. Conclusions: These results demonstrate high rates of CVD mortality, especially for stroke, compared with US Whites and Blacks, suggesting increasing rates in Western Alaska native people. Longer follow up to increase sample sizes is needed to confirm this trend, and the role of risk factors in these changes needs investigation. However, even these limited data suggest that community-based CVD prevention is needed in these populations.

Relationship between Inflammatory Cytokines and Uric Acid Levels with Adverse Cardiovascular Outcomes in Patients with Stable Coronary Heart Disease

BackgroundSo far it is unclear whether the association between serum uric acid (SUA), inflammatory cytokines and risk of atherosclerosis is causal or an epiphenomenon. The aim of the project is to investigate the independent prognostic relationship of inflammatory markers and SUA levels with adverse cardiovascular outcomes in a patient population with stable coronary heart disease (CHD).MethodsSUA, C-reactive protein (CRP) and interleukin (IL)-6 were measured at baseline in a cohort of 1,056 patients aged 30–70 years with CHD. Cox proportional hazards model was used to determine the prognostic value of these markers on a combined CVD endpoint during eight year follow-up after adjustment for covariates.ResultsFor 1,056 patients with stable coronary heart disease aged 30–70 years (mean age 58.9 years, SD 8.0) follow-up information and serum measurements were complete and n = 151 patients (incidence 21.1 per 1000 patients years) experienced a fatal or non-fatal CVD event during follow-up (p-value = 0.05 for quartiles of SUA, p = 0.002 for quartiles of CRP, p = 0.13 for quartiles of IL-6 in Kaplan-Meier analysis). After adjustment for age, gender and hospital site the hazard ratio (HR) for SUA increased from 1.37 to 1.65 and 2.27 in the second, third, and top quartile, when compared to the bottom one (p for trend <0.0005). The HR for CRP increased from 0.85 to 0.98 and 1.64 in the respective quartiles (p for trend 0.02). After further adjustment for covariates SUA still showed a clear statistically significant relationship with the outcome (p for trend 0.045), whereas CRP did not (p for trend 0.10).ConclusionThe data suggest that compared to inflammatory markers such as CRP and IL-6 serum uric acid levels may predict future CVD risk in patients with stable CHD with a risk increase even at levels considered normal.

Abstract P264: Meeting 2008 Physical Activity Guidelines for Americans Reduces Risk of Recurrent CVD Events in MI Survivors: The Western New York Acute MI Study (1996–2006)

Introduction: The 2008 Physical Activity Guidelines for Americans (PAG) recommend adults perform at least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity or an equivalent combination of both in order to obtain important health benefits, including lower CHD risk. Despite advances in clinical medicine, survivors of MI remain at substantial risk of recurrent cardiovascular events and death. The aim of our prospective study was to examine whether meeting the PAG reduced risk of recurrent CVD events in MI patients. Hypothesis: We hypothesized that MI survivors who met the current PAG had a more favorable prognosis than those who did not meet the guidelines. Methods: Incident MI cases (933 men, 354 women, 35–69 years old) recruited from 12 of 15 Western NY hospitals completed an interviewer-administered survey and clinic exam. Physical activity (PA) in the previous seven days was assessed using the Stanford 7-day PA recall. Minutes reported in moderate and vigorous intensity recreational, household and occupational activity (MVPA) were summed and participants were categorized as follows (min/week): inactive (0), insufficiently active (&gt;0–&lt;150), met (150–300), and exceeded the guideline goal (&gt;300). Participant surveys, medical records and a search of the National Death Index Plus were used to determine fatal and non-fatal recurrent CVD (ICD9 390–450) events. Cox regression analysis adjusting for age (in years), gender, education (in years), race, BMI, smoking status, hypertension and use of diabetes and lipid medication was conducted to examine the association between PA and recurrent events. Results: During a mean follow up of 4.1 years, 301 recurrent CVD events occurred. At baseline, 174 (13.5%) participants reported no MVPA, 216 (16.8%) were insufficiently active, whereas 259 (20.1%) met and 638 (49.6%) exceeded the PAG, respectively. Multivariate adjusted hazard ratios (95% CI) for recurrent CVD events were Inactive [Ref (1.00)], insufficiently active [0.68 (0.46–1.01)], met [0.63 (0.43–0.92)], and exceeded the guideline goal [0.63 (0.45–0.87)], p-trend =0.019. Conclusion: In this prospective population-based study, there is evidence to support that meeting the 2008 Physical Activity Guidelines for Americans has significant benefits on fatal and non-fatal recurrent CVD events in men and women following myocardial infarction.

Abstract P389: Cardiovascular Disease Mortality Risk Prediction in Educational Classes across European Regions, in the MORGAM Project Populations

Aims: Although socioeconomic status is a recognized independent risk factor for CVD mortality, the recommended European risk prediction equation for primary prevention does not consider it; an approach criticized by previous results in the UK and US. We aim to assess whether the SCORE project equation adequately estimates the risk in different educational classes, across several European populations. Methods: We considered 47 prospective population-based surveys from Nordic Countries (Finland, Denmark, Sweden), UK (Belfast and Scotland), Central Europe (France, Germany and Italy) and East Europe (Lithuania, Poland) and Russia. Baseline data collection and mortality follow-up (median time 10 years) adhered to standardized MONICA-like procedures. Three educational classes were derived from population-, sex- and birth year-specific tertiles of years of schooling. The individual SCORE risk was computed from age, total cholesterol, systolic blood pressure and smoking; the risk was recalibrated to the average observed risk in each population. We estimated age- and traditional risk factors-adjusted hazard ratios (HR) for 10 year CVD mortality (highest education as the reference), from Cox models. Moreover, the observed number of fatal CVD events by educational class was compared to the expected number, as estimated by the recalibrated SCORE function. Results: The cohorts summed-up 39,215 men and 29,240 women 40 to 64 years old and free from CVD event at baseline. Education was associated with CVD mortality in men (pooled age-adjusted HR for low vs high education: 1.6, 95% CI 1.4–1.9); the hazard ratios ranged from 1.3 (95%CI: 0.9–1.8) in Central Europe to 2.1 (1.6–2.7) in East Europe and Russia. The association attenuated after adjustment for SCORE risk factors and HDL-cholesterol. Among women, the association was significant in Nordic Countries only (age-adjusted HR for low vas high education: 1.7, 95% CI 1.1–2.6), but it was no more significant after adjustment for multiple risk factors. The original SCORE equation overestimated the risk at a population level, both in men and in women, except in East Europe and Russia. After recalibration, the SCORE equation overestimated the risk among the more educated men by 20% to 50% (in Central Europe, East Europe and Russia, respectively), but underestimated it in the less educated men by 7% to 23% (in Central Europe, East Europe and Russia, respectively). Conclusions: Our results, based on a well-harmonized study comprising several European populations, suggest the need to include country-specific socioeconomic status in the risk estimation equations.