Favorable Risk Factor Profile Research Articles

Limited health literacy is associated with low glomerular filtration in the Chronic Renal Insufficiency Cohort (CRIC) study

Background: Low health literacy in the general population is associated with increased risk of death and hospitalization. The evaluation of health literacy in individuals with predialysis chronic kidney disease (CKD) is limited. Methods: We conducted a cross-sectional study to evaluate the associations of limited health literacy with kidney function and cardiovascular disease (CVD) risk factors in 2,340 non-Hispanic (NH) Whites and Blacks aged 21 – 74 years with mild-to-moderate CKD. Limited health literacy was defined as a Short Test of Functional Health Literacy in Adults (STOFHLA) score ≤ 22. Outcomes evaluated included estimated glomerular filtration rate (eGFR), 24-hour urine protein excretion, and CVD risk factors. Results: The prevalence of limited health literacy was 28% in NH-Blacks and 5% in NH-Whites. Compared with participants with adequate health literacy, those with limited health literacy were more likely to have lower eGFR (34 vs. 42 mL/min/1.73 m2); higher urine protein/24-hours (0.31 vs. 0.15 g); and higher self-reported CVD (61 vs. 37%); and were less likely to have BP < 130/80 mmHg (51 vs. 58%); p ≤ 0.01 for each comparison. After adjustment, limited health literacy was associated with self-reported CVD (OR 1.51, 95% CI 1.13 – 2.03) and lower eGFR (β –2.47, p = 0.03). Conclusion: In this CKD cohort, limited health literacy was highly prevalent, especially among NH-Blacks, and it was associated with lower eGFR and a less favorable CVD risk factor profile. Further studies are needed to better understand these associations and inform the development of health literacy interventions among individuals with CKD.

Follow-up of ischaemic heart disease in patients with coeliac disease

Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6-10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04-1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61-0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD.

Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis

Objective To determine the association between self reported job insecurity and incident coronary heart disease. Design A meta-analysis combining individual level data from a collaborative consortium and published studies identified...

The fractionalization of physical activity throughout the week is associated with the cardiometabolic health of children and youth.

BackgroundThe influence of the fractionalization of moderate- to vigorous- intensity physical activity (MVPA) throughout the week on the health of children is unknown. We compared cardiometabolic risk factors in physically active children who accumulated their weekly MVPA in different patterns.MethodsWe studied 745 participants aged 6–19 years. MVPA was measured using accelerometers over 7 days. Three groups were created: Insufficiently Active, <60 minutes/day of MVPA on average; Infrequently Active, ≥60 minutes/day of MVPA on average but exceeding the 60 minute target <5 days; and Frequently Active, ≥60 minutes/day MVPA on average and exceeding the 60 minute target ≥5 days. Percentile scores for 8 cardiometabolic risk factors were determined.ResultsThe least favorable cardiometabolic risk factor profile was observed in the Insufficiently Active group. The Frequently Active group had more favorable (5–6 percentile unit difference) diastolic blood pressure, HDL-cholesterol, insulin resistance, and metabolic syndrome scores than the Infrequently Active group, although only the difference for insulin resistance was statistically significant (P < 0.05). These differences remained after controlling for the weekly volume of MVPA.ConclusionThe fractionalization of MVPA throughout the week was associated with insulin resistance.

Abstract P126: Relation of Depressive Symptoms to the Cross-Sectional and Longitudinal Association of Low Cardiovascular Risk with Subclinical Atherosclerosis - The Chicago Healthy Aging Study (CHAS)

Background: Previous findings on the association of depressive symptoms and subclinical cardiovascular disease (CVD) have been inconsistent. This study aimed to (1) examine the cross-sectional association between depressive symptoms (DS) and subclinical atherosclerosis in older age; and (2) determine whether presence of DS at older age relates to the long-term low-order association of favorable CVD risk factor profile (low-risk) at younger age with subclinical atherosclerosis in older age. Methods: CHAS participants (n=1,395) were examined in 1967-1973 (baseline) and 2007-2009 (follow-up). Baseline low-risk was defined as: (1) blood pressure ≤120/≤80 mmHg and no reported use of antihypertensive medication, (2) serum cholesterol &lt;200 mg/dL and no reported use of lipid-lowering medication, (3) BMI &lt; 25.0 kg/m 2 , (4) no diabetes, and (5) no smoking; not low-risk included all others. DS (≥16 on the Center for Epidemiologic Studies Depression Scale [CES-D]) and presence of coronary artery calcification (CAC) &gt;0 (determined by computed tomography) were assessed at follow-up. Results: Among 1,130 CHAS participants with complete data (mean follow-up age=71.1), 6.9% met criteria for DS. Individuals with DS reported lower sleep quality ( p &lt;0.0001) and were more likely to be African American (p&lt;0.0001). At older age, DS were not associated with CAC&gt;0 after multivariate adjustment ( p =0.38). Prevalence of DS did not vary significantly between baseline low-risk and not low-risk participants (5.8% and 7.2%, p =0.45). Regardless of late-life depressive symptom status, presence of CAC (indicated by CAC scores &gt; 0) was less likely among low-risk persons ( p =0.21) (Table 1). Results were consistent across different CAC score cut-points (data not shown). Conclusion: Depressive symptoms in older age were not associated with subclinical atherosclerosis or CVD risk status. Low CVD risk status in early-middle age was associated with lower CAC prevalence in older age among persons both with and without depressive symptoms.

Abstract MP08: Cardiovascular Health and Incident Cardiovascular Disease and Cancer

Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. A favorable risk factor and behavior profile, reflected by a metric of cardiovascular health (CV health) recently introduced by the AHA, predict a lower risk of CVD in younger populations, yet has not been well-characterized in older adults. Achieving ideal CV health may also lower cancer risk, since cancer and CVD share common risk factors. We used multivariable Cox regression to estimate hazard ratios (HR) for the association between CV health and incident CVD and cancer, respectively, among Women’s Health Initiative (WHI) participants. We characterized CV health as the number [0 (worst) - 7 (best)] of ideal CV health behaviors and factors at baseline: 1) never smoking, or quit for &gt;1 yr; 2) body mass index &lt;25 kg/m 2 ; 3) physical activity of ≥150 min/wk moderate, ≥75 min/wk vigorous, or ≥150 min/wk moderate and vigorous; 4) at least 4 of 5 healthy diet components (≥4.5 cups/day of fruits and vegetables; ≥3.5 oz servings/wk of fish; ≥3 1-oz servings/day of whole grains; &lt;1,500 mg/day of sodium; and ≤36 oz/wk of sugar-sweetened beverages); 5) total cholesterol (untreated) &lt;200 mg/dL; 6; blood pressure (untreated) &lt;120 mmHg / &lt;80 mmHg; and 7) fasting glucose (untreated) &lt;100 mg/dL. Approximately 300 women (&lt;1%) had a CV health score of 7 (best) in both CVD- and cancer-free groups at baseline. Among 115,302 women free of CVD at baseline, the hazard of CVD was inversely related to CV health (Figure 1a), controlling for age, race/ethnicity, family history, marital status, and education. Among 129,145 women free of cancer at baseline (Figure 1b), we observed a similar pattern, controlling for the same factors, although HRs were of smaller magnitude. Lower CV health is associated with an increased risk of CVD and cancer in older post-menopausal women, emphasizing the importance of prevention efforts among older adults. Figure 1. HRs and 95% CIs for (a) incident CVD and (b) incident cancer by ideal CV health score: WHI observational study participants

Confounding and studies of ‘moderate’ alcohol consumption: the case of drinking frequency and implications for low‐risk drinking guidelines

Many observational studies suggest that increased drinking frequency is associated with reduced mortality among those with low-dose alcohol consumption. The purpose of this paper was to examine whether frequent drinkers consume lower-risk amounts during drinking days or have favorable risk factor profiles compared with those who drink less frequently, and discuss implications for the larger debate about the limitations of non-randomized studies about 'moderate' drinking and the development of low-risk drinking guidelines. Data from the 2008 Behavioral Risk Factor Surveillance System survey were used to characterize alcohol consumption characteristics and their relationship with risk factors among adult drinking men who consumed an average of fewer than two drinks per day and adult drinking adult women who consumed an average of less than one drink per day. Those who drank relatively infrequently (14 or fewer days per month) consumed more during drinking days, were more likely to exceed the US Dietary Guidelines drinking limits (41.0% versus 9.7%) and had a larger proportion of drinking days that included binge drinking (13.4% versus 4.3%). Infrequent drinkers also had a higher prevalence of 13 of 15 risk factors assessed. Findings from analyses of those aged ≥40 years were similar. Among those with low average alcohol consumption, infrequent drinkers drink more during drinking days and have unfavorable risk factors profiles compared with more frequent drinkers, suggesting that confounding may contribute to favorable associations with 'moderate' average alcohol consumption and increased drinking frequency observed in non-randomized studies.

Sedentary behaviour and clustered metabolic risk in adolescents: The HELENA study

Background and aimsAlthough sedentary behaviours are linked with mortality for cardiovascular reasons, it is not clear whether they are negatively related with cardio-metabolic risk factors. The aim was to examine the association between time engaged in television (TV) viewing or playing with videogames and a clustered cardio-metabolic risk in adolescents. Methods and resultsSedentary behaviours and physical activity were assessed in 769 adolescents (376 boys, aged 12.5–17.5 years) from the HELENA-CSS study. We measured systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO2max and the sum of four skinfolds, and a clustered metabolic risk index was computed. A multilevel regression model (by Poisson) was performed to calculate the prevalence ratio of having a clustered metabolic risk. In boys, playing >4 h/day with videogames (weekend) and moderate to vigorous PA (MVPA) was associated with cardio-metabolic risk after adjustment for age, maternal education and MVPA. In contrast, TV viewing was not associated with the presence of cardio-metabolic risk. ConclusionIn boys, playing with videogames may impair cardio-metabolic health during the adolescence. Adolescents should be encouraged to increase their participation in physical activity of at least moderate intensity to obtain a more favourable risk factor profile.

Socioeconomic Status, Cardiovascular Risk Factors, and Subclinical Atherosclerosis in Young Adults

The goal of this study was to investigate the extent to which socioeconomic status (SES) in young adults is associated with cardiovascular risk factor levels and carotid intima-media thickness (IMT) and their changes over a 6-year follow-up period. The study population included 1813 subjects participating in the 21- and 27-year follow-ups of the Cardiovascular Risk in Young Finns Study (baseline age 24-39 years in 2001). At baseline, SES (indexed with education) was inversely associated with body mass index (P=0.0002), waist circumference (P<0.0001), glucose (P=0.01), and insulin (P=0.0009) concentrations; inversely associated with alcohol consumption (P=0.02) and cigarette smoking (P<0.0001); and directly associated with high-density lipoprotein cholesterol levels (P=0.05) and physical activity (P=0.006). Higher SES was associated with a smaller 6-year increase in body mass index (P=0.001). Education level and IMT were not associated (P=0.58) at baseline, but an inverse association was observed at follow-up among men (P=0.004). This became nonsignificant after adjustment with conventional risk factors (P=0.11). In all subjects, higher education was associated with a smaller increase in IMT during the follow-up (P=0.002), and this association remained after adjustments for conventional risk factors (P=0.04). This study shows that high education in young adults is associated with favorable cardiovascular risk factor profile and 6-year change of risk factors. Most importantly, the progression of carotid atherosclerosis was slower among individuals with higher educational level.

O3-2.2 Linkage of census with mortality and cancer data in New Zealand. [part of symposium ref number 2353, "linkage of data in the study of ethnic inequalities ..."

<h3>Introduction</h3> Ethnicity is difficult to collect in a standard way between health and census datasets, meaning routinely calculated rates are prone to numerator-denominator bias. <h3>Methods</h3> Census and mortality data have been routinely linked in the New Zealand Census-Mortality Study, creating time series data from 1981. More recently, the Cancer trends study has linked cancer registrations. The proportion of eligible mortality / cancer records linked to a census record is now over 80%. Weighting is used to adjust for any linkage bias. <h3>Results</h3> Previously calculated mortality rates for Māori and Pacific people were shown to be underestimated by a quarter due to numerator-denominator bias. Corrected trends in mortality rates since 1981 demonstrate little if any improvement in Māori mortality rates during the 1980s–90s, concurrent with major reforms that impacted more on Māori than non-Māori (eg, unemployment rates among Māori reached 25% in 1992, compared with 7% among Europeans). Other analyses demonstrate that CVD is the major cause of death giving rise to ethnic inequalities in mortality, but as CVD rates fall for all ethnic groups inequalities in mortality are “relocating” to cancer. Inequalities in cancer incidence are less prominent than inequalities in cancer mortality, but nevertheless there are curious findings, such as: higher (and faster rising) breast cancer incidence among Māori, despite a more favourable risk factor profile; and particularly high endometrial and thyroid cancer incidence among Pacific women. There has also been a tremendous reduction in cervical cancer inequalities. <h3>Conclusion</h3> This linkage has allowed accurate research on trends that was hitherto impossible.

Abstract A89: HER2-overexpressing tumors and time since last pregnancy

Abstract Background: Risk of dying from breast cancer is higher among Hispanic women compared to non-Hispanic whites (NHW) despite lower overall incidence rates and a more favorable risk factor profile. Part of the observed disparity can be explained by aggressive tumor biology although unequal access to care is also a key factor. A recent pooled case-only study suggests Hispanic women are more likely to be diagnosed with HER2-positive tumors compared to NHWs. Given the high parity rates among Hispanics and recent interest in the differential effect of reproductive factors on breast tumor subtypes, we investigated the relative correlation between reproductive factors and tumor phenotype stratified on HER2 status. Methods: A total of 459 women of Mexican origin from the case-only ELLA Binational Breast Cancer Study were classified into hormone receptor (HR) positive cases (estrogen or progesterone-receptor positive, HER2-negative) and HER2-overexpressing cases (HER2+, HR-). Women negative for all three markers (triple negative) were not considered in these analyses. Reproductive factors considered in the analysis include age at first full-term pregnancy, total number of full-term pregnancies, ever breastfeeding, breastfeeding after last pregnancy, and time since last pregnancy. Time to diagnosis since last pregnancy was classified as either ≤10 years or &amp;gt;10 years. We conducted separate analyses for women diagnosed at ≤ 40 years (n=72) and at &amp;gt;40 years of age (n=386). Differences were tested using a Pearson chi-square test or Student's t-test. We calculated case-case odds ratios (OR) and 95% confidence intervals (CI) using logistic regression to estimate the relative correlation between time since last pregnancy and HER2+ tumors in reference to HR+ tumors. Models included age at diagnosis, recruitment site, age at first pregnancy, number of pregnancies and breastfeeding. Results: Out of 459 women, 338 (74%) were HR+ and 121 (26%) HER2+. No significant differences were observed in the proportion of HR+ tumors among women ≤ 40 and those &amp;gt; 40 (79% vs. 73%, respectively; p=0.22). HER2+ cases were younger at diagnosis compared to HR+ cases (mean age 51.8 vs. 53.1, respectively; p= 0.30). HER2+ cases were more likely to be diagnosed after the age of 40 compared to HR+ cases (OR 4.37; 95% CI: 1.84,10.40) and were more likely to occur within the 10-year period following the last pregnancy (OR=3.99; 95% CI: 1.95,8.16). No difference was observed for age at first full-term pregnancy (OR 0.99; 95% CI: 0.95,1.03), number of full-term pregnancies (OR 0.95; 95% CI: 0.84,1.07) or ever breastfeeding (OR 0.98; 95% CI: 0.59,1.62). A significant interaction was observed between time since last pregnancy and age at diagnosis (p=0.03). Stratified results suggest the relationship between time since last pregnancy and tumor phenotype is stronger in the &amp;gt;40 age group (OR 3.68; 95% CI: 1.60,8.44) compared to those ≤40 (OR 2.68; 95% CI: 0.19,37.16). Conclusions: HER2+ tumors were more likely to be diagnosed in the 10-year period after the last pregnancy compared to HR+ tumors, independent of age. These findings suggest a relationship between HER2+ breast cancer and pregnancy history that differs from that with HR+ tumors, supporting the presence of etiologic heterogeneity in these subtypes. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A89.

Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007

Although people of South Asian, Chinese and black ethnic backgrounds represent about 60% of the world's population, most knowledge of cardiovascular risk is derived from studies conducted in white populations. We conducted a large, population-based comparison of cardiovascular risk among people of white, South Asian, Chinese and black ethnicity living in Ontario, Canada. We examined the age- and sex-standardized prevalence of eight cardiovascular risk factors, heart disease and stroke among 154,653 white people, 3364 South Asian people, 3038 Chinese people and 2742 black people. For this study, we pooled respondent data from five cross-sectional health surveys conducted between 1996 and 2007: the National Population Health Survey of 1996 and the Canadian Community Health Survey, versions 1.1, 2.1, 3.1 and 4.1. The four ethnic groups varied considerably in the prevalence of the four major cardiovascular risk factors that we examined: for smoking, South Asian 8.6%, Chinese 8.7%, black 11.4% and white 24.8%; for obesity, Chinese 2.5%, South Asian 8.1%, black 14.1% and white 14.8%; for diabetes mellitus, white 4.2%, Chinese 4.3%, South Asian 8.1% and black 8.5%; and for hypertension, white 13.7%, Chinese 15.1%, South Asian 17.0% and black 19.8%. The prevalence of heart disease ranged from a low of 3.2% in the Chinese population to a high of 5.2% in the South Asian population, and the prevalence of stroke ranged from a low of 0.6% in the Chinese population to a high of 1.7% in the South Asian population. Although the black population had the least favourable cardiovascular risk factor profile overall, this group had a relatively low prevalence of heart disease (3.4%). Ethnic groups living in Ontario had striking differences in cardiovascular risk profiles. Awareness of these differences may help in identifying priorities for the development of cardiovascular disease prevention programs for specific ethnic groups.

Changes in lifestyle, biological risk factors and total homocysteine in relation to MTHFR C677T genotype: a 5-year follow-up study

Total homocysteine (tHcy) has been associated with increased risk of several diseases in the general population. It is not clear whether these associations are causal. A less healthy lifestyle as well as a less favorable biological risk factor profile have been related to increased tHcy in cross-sectional studies. In addition, the methylenetetrahydrofolate reductase (MTHFR) C677T gene variant is an important determinant of elevated tHcy. The main objective of the study was to examine the effect of changes in biological risk factors and lifestyle on tHcy in relation to MTHFR C677T genotype. The study is a population-based study including 1805 men and women aged 30-60 years participating in a health examination at baseline (1999-2001) and at a 5-year follow-up examination. Changes in tHcy were not associated with changes in dietary habits, physical activity, smoking status, coffee, tea, total alcohol or wine consumption. An inverse relationship was observed between changes in tHcy and changes in the intake of beer in TT individuals but not in CC/CT individuals (P (interaction)=0.01). In addition, changes in tHcy were positively associated with changes in several biological risk factors, such as waist circumference, diastolic blood pressure, total cholesterol and LDL cholesterol (P<0.01). The association between waist circumference and MTHFR genotype seemed stronger in TT individuals than in CC/CT individuals (P (interaction)=0.03). tHcy was not influenced by lifestyle changes except for the inverse association between beer consumption and tHcy observed in TT individuals. This suggests that tHcy is not a mediator in the causal pathway between lifestyle and lifestyle-related diseases such as cardiovascular disease in accordance with results of recent randomized trials. However, tHcy was related to changes in several biological risk factors, suggesting that tHcy may be a good predictor or marker of disease.

Low‐risk factor profile, estrogen levels, and breast cancer risk among postmenopausal women

Obesity, alcohol consumption, physical inactivity and postmenopausal hormone use are known modifiable risk factors for breast cancer. We aim to measure incidence rates of breast cancer for women with favorable levels on all 4 risk factors (BMI <or= 30 kg/m(2), alcohol <1 drink/week, physically active and no current hormone use) and to evaluate their associations with estrogen. The 5,054 postmenopausal women in the Copenhagen City Heart Study were asked about risk factors at baseline in 1981-3 and were followed until 2002 in the Danish Cancer Registry, with <0.1% loss to follow-up. Estradiol was measured in a subset of 1,042 women. During follow-up, 263 women developed breast cancer. Twenty-six percent of the women had a favourable risk factor profile, and their breast cancer rates were markedly lower (154 per 100,000 years) than women with 3+ risk factors (460 per 100,000 years). One, two and three risk factors were associated with hazard ratios of 1.38 (95% CI: 0.99; 1.92), 1.84 (1.26; 2.67) and 2.79 (1.59; 4.88) compared to women with a favourable profile. Each of the risk factors was associated with estrogen. In conclusion, the risk of breast cancer was markedly lower for women with a favourable risk profile than for other women and lower estrogen levels is a possible explanation.

Comparison of Treatment and Outcome of Acute Coronary Syndrome in Patients With Versus Patients Without Diabetes Mellitus

The aim was to evaluate management and outcomes in patients with diabetes mellitus (DM) with acute coronary syndrome (ACS). The EHS-ACS-II was a multinational survey conducted in 2004 that included 6,385 consecutive patients with ACS. The management and outcomes of patients with and without DM were compared. DM was recognized in 1,587 patients (25%) with ACS. Patients with DM had a less favorable risk-factor profile, less typical presentation, and longer delay in seeking medical attention; presented more frequently with arrhythmias, heart failure, renal failure, and major bleeding; and had higher in-hospital and 1-year mortality. They were treated more often with diuretics and inotropic agents and less often with antiaggregants (glycoprotein IIb/IIIa and clopidogrel). Insulin was administered to 53% of patients with DM during hospitalization and 31% at discharge. Patients with DM with ST-elevation (STE) myocardial infarction underwent similar primary percutaneous and coronary interventions (but received less thrombolytic therapy). Patients with DM with non-STE ACS underwent less in-hospital revascularization and had significantly higher 1-year mortality. Multivariable analyses showed DM as a predictor of 1-year mortality (odds ratio 1.37, 95% confidence interval 1.09 to 1.71), but not in-hospital mortality. In conclusion, given the current treatment, patients with and without DM with ACS had similar in-hospital adjusted mortality, but patients with DM had increased 1-year mortality. Patients with DM with non-STE ACS posed a higher risk group.

Cardiovascular risk factors among youth with and without type 2 diabetes: differences and possible mechanisms.

OBJECTIVE—To compare cardiovascular disease (CVD) risk factors among recently diagnosed youth with type 2 diabetes and nondiabetic youth and investigate whether demographic, behavioral, or metabolic factors might account for observed differences.RESEARCH DESIGN AND METHODS—Data from 106 type 2 diabetic and 189 nondiabetic multiethnic youth, aged 10–22 years, were analyzed. Prevalence of CVD risk factors were age and race/ethnicity adjusted using direct standardization. Multiple linear regression models were sequentially adjusted for demographic, behavioral (dietary saturated fat intake and physical activity), and metabolic (body adiposity and glycemia) factors to explore possible mechanisms associated with differences in CVD risk factors between the case and control groups.RESULTS—Compared with control subjects, youth with type 2 diabetes had a higher prevalence of elevated blood pressure, obesity, large waist circumference, low HDL cholesterol, high triglycerides, and high albumin-to-creatinine ratio (P < 0.05 for each risk factor). Type 2 diabetic youth also had higher levels of apolipoprotein B, fibrinogen, interleukin (IL)-6, C-reactive protein, and leptin; lower adiponectin levels; and denser LDL particles (P < 0.05 for each risk factor). Adjustment for BMI, waist circumference, and A1C substantially attenuated differences in the CVD risk factors between the case/control groups, except for fibrinogen and IL-6, which remained significantly higher in type 2 diabetic youth.CONCLUSIONS—Compared with control youth, type 2 diabetic youth have a less favorable CVD risk factor profile. Adiposity and glycemia are important contributors to differences in CVD risk profiles among type 2 diabetic and control youth. Inflammatory and prothrombotic factors may also play an important role.

Cardiovascular Disease Risk Profiles in Women With Histories of Gestational Diabetes but Without Current Diabetes

To compare the cardiovascular disease risk factor profiles of parous women with a history of gestational diabetes who had not developed diabetes, parous women with diagnosed diabetes, and parous women with neither condition. We conducted cross-sectional analyses of 4,631 parous women who were not currently pregnant in the Third National Health and Nutrition Examination Survey (1988-1994). Women were classified by self-report as having a history of gestational diabetes who were not currently diabetic (n=85), diagnosed diabetics (n=218), or as having neither condition (n=4,328). We compared these groups with respect to cholesterol subtypes, blood pressure, uric acid, microalbuminuria, insulin, glucose, and clustering of risk factors, before and after adjustment for demographic and behavioral factors and central obesity. In unadjusted comparisons, women who had a history of gestational diabetes who were not currently diabetics had a more favorable or similar risk factor profile compared with unaffected women, with two exceptions: greater levels of mean fasting glucose (94.0 mg/dL compared with 106.8 mg/dL, P<.001) and mean fasting insulin (10.2 international units/L compared with 14.0 international units/L, P<.001). These patterns were attenuated after adjustment for demographic factors and waist circumference, but remained significant for fasting glucose and the ratio of urine microalbumin/creatinine. Parous women with diagnosed diabetes had significantly worse cardiovascular disease risk profiles than unaffected women before and after adjustment. Women who had a history of gestational diabetes who were not currently diabetics have a similar cardiovascular disease risk profile to unaffected women, with the exception of insulin and glucose levels.

Plasminogen activator inhibitor‐1 is negatively associated with fasting plasma monounsaturated fatty acids but not influenced by postprandial polyunsaturated fatty acid composition in men with high fasting triacylglycerol

Increased consumption of dietary monounsaturated fatty acids (MUFA) is associated with a favorable risk factor profile associated with the metabolic syndrome (MetS), including lowered plasminogen activator inhibitor (PAI)‐1. In addition, the postprandial response to dietary fat has emerged as a dynamic metabolic period associated with MetS. Plasma fatty acid composition was measured in men with high fasting triacylglycerol (n=8, HTAG&gt;1.69 mmol/L) and low fasting TAG (n=8, LTAG&lt;1.7 mmol/L). Each subject underwent three postprandial oral fat tolerance tests (OFTT) of 1g/kg body weight emulsified lipids consisting of varied PUFA/saturated fatty acid (P/S) ratios of 0.2, 1.0 and 2.0, with blood collected through 8h. Fasting MUFA was negatively correlated with total PAI‐1 antigen (P&lt;0.001, r=−0.98) and PAI‐1 activity (P&lt;0.02, r=−0.8) in HTAG, but not LTAG. Fasting total PUFA concentration was positively correlated with total PAI‐1 antigen (P=0.03, r=0.75) in HTAG, but not LTAG. There was no difference in postprandial PAI‐1 total or activity in response to three OFTTs with similar MUFA but varied PUFA TAG composition. These data suggest that elevated MUFA concentrations may have beneficial effects on PAI‐1 in HTAG subjects and that postprandial PUFA concentrations do not influence postprandial PAI‐1 in this population.Supported by the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) and NSERC

Comparison of electrocardiographic findings and associated risk factors between Taiwan Chinese and US White adults

Background Electrocardiographic (ECG) findings are known to differ by race, however, systematic comparisons of findings between eastern and western countries are rare. Objective To compare the ECG findings and associated coronary heart disease (CHD) risk factors between Taiwan Chinese and US White adults aged ≧ 40 years. Methods We compared the prevalence rate of Minnesota Code criteria based ECG findings and associated CHD risk factors by using data from the third National Health and Nutrition Examination Survey (NHANES III) and the Nutrition and Health Survey in Taiwan (NAHSIT, 1993–1996). Results Examining all the ECG findings collectively, we observed a higher prevalence of major Minnesota Code findings in Taiwan Chinese women than in US White women (15.0% vs. 10.5%), particularly ST segment depression (5.4% vs. 2.4%) and T wave abnormalities (10.8% vs. 4.8%). The prevalence of major Minnesota Code findings was similar in both Taiwan Chinese and US White men (22.7% vs. 19.6%). Taiwan Chinese men had a higher prevalence of ST segment elevation (13.7% vs. 0.9%). Taiwan Chinese also had a higher prevalence of left ventricular hypertrophy with repolarization change than US Whites in both sexes (2.7% vs. 1.4% for men, 4.3% vs. 1.3% for women). Taiwan Chinese had more favorable CHD risk factor profiles than US Whites, including lipid profile, obesity, central obesity, and smoking status. The prevalence of hypertension was similar between the two groups, however, a lower percentage of Taiwan Chinese received treatment. Taiwan Chinese men had a lower prevalence of diabetes mellitus than US White men, whereas Taiwan Chinese women had a higher prevalence than US White women. Conclusion These results suggest that substantial differences in ECG findings exist between Taiwan Chinese and US Whites which cannot be entirely explained by CHD risk factors alone.

Low-Risk Profile for Cardiovascular Disease and Mortality in Japanese

Some studies focusing on low-risk profiles for cardiovascular disease have been reported in Western countries. Yet, few reports have examined, with substantial longevity, the low-risk profile for cardiovascular disease in the Japanese population. This study examines whether having a favorable risk factor profile yields lower all-cause mortality and whether the proportion of those with a low-risk profile is larger in the Japanese population. A total of 8,339 men and women aged 30-69 years without a history of cardiovascular diseases for 19 years, who had participated in the 1980 National Survey on Circulatory Disorders after being randomly selected from throughout Japan, were followed. Low risk was defined as having all of the following baseline characteristics: blood pressure (BP) <120/80 mmHg; no antihypertensive medication; serum cholesterol 160-240 mg/dl (4.14-6.22 mmol/L); no history of diabetes; and non-smoker. The long-term mortality of the low-risk group was compared with that of others using the Cox proportional hazard model. The prevalence of low risk was 9.4% of all participants. The multivariate-adjusted hazard ratios for low-risk individuals compared with others were as follows: 0.33 (95% confidence intervals (CI), 0.15-0.74) for cardiovascular disease and 0.63 (95% CI, 0.46-0.88) for all-cause mortality. The most attributable risk factor for all-cause mortality was high BP (>or=120/80 mmHg). Japanese individuals with favorable cardiovascular disease risk profiles had lower mortality from cardiovascular disease and all-causes than those without.